Viral encephalitis after haplo-identical hematopoietic stem cell transplantation: Causative viral spectrum, characteristics, and risk factors
Viral encephalitis after haplo-identical hematopoietic stem cell transplantation: Causative viral spectrum, characteristics, and risk factors
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单倍体相合造血干细胞移植后病毒性脑炎：致病病毒谱、特征和危险因素
DOI：
10.1111/ejh.12855
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发表时间：
2017
影响因子：
3.1
通讯作者：
Huang Xiao-Jun
中科院分区：
文献类型：
--
作者：
Zhang Xiao-Hui;Zhang Jia-Min;Han Wei;Chen Huan;Chen Yu-Hong;Wang Feng-Rong;Wang Jing-Zhi;Zhang Yuan-Yuan;Mo Xiao-Dong;Chen Yao;Wang Yu;Chang Ying-Jun;Xu Lan-Ping;Liu Kai-Yan;Huang Xiao-Jun
目的回顾性分析接受半相合造血干细胞移植（HSCT）患者发生病毒性脑炎（VE）的特点和危险因素。从2012年至2015年接受半相合HSCT的1274例患者组成的队列中确定了VE病例和对照。结果30例患者（2.4%）中确定了VE。从HSCT到确诊的中位时间为144.5天。检出的病毒包括RSV-B（43.3%）、BKV（23.3%）、多种病毒（10%）、巨细胞病毒（CMV）（6.7%）、RSV-A（6.7%）、HSV（3.3%）、HHV-6（3.3%）和CVB 3（3.3%）。意识改变和癫痫发作是最常见的症状。神经影像学检查发现异常19例（76%）。脑脊液细胞计数、蛋白质和葡萄糖浓度分别在8例（26.7%）、18例（60%）和9例（30%）患者中升高。根据不同的致病病毒，治疗效果和并发症差异很大。多变量分析显示，急性移植物抗宿主病（III-IV级）、CMV病毒血症和移植物植入综合征与VE显著且独立相关。VE患者的累积死亡率明显高于对照组。结论发病时间、治疗反应和结局等特征因不同的致病病毒而异。
ObjectiveTo retrospectively identify characteristics and risk factors of viral encephalitis (VE) in patients who underwent a haplo‐identical hematopoietic stem cell transplant (HSCT).MethodsA nested case‐control study was designed. Cases with VE and controls were identified from a cohort composed of 1274 patients who underwent a haplo‐identical HSCT from 2012 to 2015.ResultsVE was identified in 30 patients (2.4%). The median time from HSCT to diagnosis was 144.5 days. The viruses detected included RSV‐B (43.3%), BKV (23.3%), more than one virus (10%), cytomegalovirus (CMV) (6.7%), RSV‐A (6.7%), HSV (3.3%), HHV‐6 (3.3%), and CVB3 (3.3%). Alterations of consciousness and seizures were the most frequently presented symptoms. Neuroimaging detected abnormalities in 19 (76%) patients. The cerebral spinal fluid cell count, protein, and glucose concentration were elevated in eight (26.7%), 18(60%), and nine (30%) patients, respectively. The treatment efficacy and prognoses varied considerably based on the different causative viruses. Multivariate analyses revealed that acute graft‐versus‐host disease (grade III‐IV), CMV viremia, and engraftment syndrome were significantly and independently associated with VE. The cumulative mortality rate was significantly higher in patients suffering from VE than in the controls.ConclusionCharacteristics, such as onset time, response to treatment, and outcome, varied based on the different causative viruses.