Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation.
Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation.
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DOI：
10.1007/s40121-017-0180-z
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发表时间：
2018-03
影响因子：
5.4
通讯作者：
Styczynski J
中科院分区：
文献类型：
--
作者：
Styczynski J
巨细胞病毒（CMV）是一种全球感染因子，其在人群中的感染特征是血清阳性率随年龄的增长而升高。初次感染后，CMV以潜伏形式保留在宿主细胞中，在免疫抑制的情况下可以重新激活。 CMV 复发的风险取决于免疫系统功能不全的程度，表现为 T 细胞免疫受损，包括 CMV 特异性细胞毒性 T 淋巴细胞的存在和功能。本文根据报告数据的总结，提供了免疫功能低下患者群体（包括异基因造血干细胞移植 (HSCT) 患者和其他患者群体）CMV 复发发生率的数据。 HSCT 受者中 CMV 复发率中位估计为同种异体移植后 37%、自体移植后 12%、非移植性血液恶性肿瘤患者为 5%、抗 CD52 治疗受者为 14%、实体器官移植受者为 30%、原发性免疫缺陷患者为 21%、HIV 阳性患者活跃复制期间为 20%、HIV 阳性患者在复制期间为 3.3%。抗逆转录病毒治疗，慢性肾病患者为 7%，先天性感染患者为 0.6%，原发感染新生儿为 0.6%。据报道，无论供体血清状态如何，HSCT CMV 血清阳性受者的 CMV 复发和 CMV 疾病风险最高。受者阳性与受者阴性 CMV 血清状态移植（OR 8.0）、供者阴性/受者阳性与供者阳性/受者阳性 CMV 血清状态移植（OR 1.2）、不相关/不匹配与匹配家庭供者移植（OR 1.6）以及急性移植物抗宿主病与其他疾病（OR 3.2）。其他风险因素影响较小。
Cytomegalovirus (CMV) is an agent of global infection, and its acquisition in a population is characterized by an age-dependent rise in seropositivity. After primary infection, CMV remains in the host cells in latent form, and it can reactivate in the case of immune suppression. The risk of CMV recurrence is dependent on the level of incompetency of the immune system, manifested as an impairment of T-cell immunity, including the presence and function of CMV-specific cytotoxic T lymphocytes. This article presents data on the incidence of CMV recurrence in groups of immunocompromised patients, including allogeneic hematopoietic stem cell transplantation (HSCT) patients and other groups of patients, based on a summary of reported data. The median rate of CMV recurrence in HSCT recipients was estimated as 37% after allogeneic transplant and 12% after autologous transplant, 5% in patients with nontransplant hematological malignancies, 14% in recipients of anti-CD52 therapy, 30% in solid organ transplant recipients, 21% in patients with primary immunodeficiencies, 20% during active replication in HIV-positive patients and 3.3% during antiretroviral therapy, 7% in patients with chronic kidney disease, 0.6% in patients with congenital infection, and 0.6% in neonates with primary infection. The highest risk of CMV recurrence and CMV disease is reported for HSCT CMV-seropositive recipients, regardless of donor serostatus. The odds ratio (OR) for CMV recurrence is higher for recipient-positive versus recipient-negative CMV serostatus transplants (OR 8.0), donor-negative/recipient-positive versus donor-positive/recipient-positive CMV serostatus transplants (OR 1.2), unrelated/mismatched versus matched-family donor transplants (OR 1.6), and acute graft-versus-host-disease versus other diseases (OR 3.2). Other risk factors have minor significance.
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通讯作者：
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