Peinemann F, de Villiers E M, Dörries K, Adams O, Vögeli T A, Burdach S
Zentrum für Kinderheilkunde, Klinik für Pädiatrische Hämatologie und Onkologie, Heinrich-Heine-Universität, Düsseldorf, Germany.
Eur J Pediatr. 2000 Mar;159(3):182-8. doi: 10.1007/s004310050047.
Of a total of 117 bone marrow transplant (BMT) recipients in the period from August 1988 to November 1995, 9 (7.7%) developed haemorrhagic cystitis. This condition was characterized in all nine patients by late onset (day +24 to +50 post-BMT), long duration (1 to 7 weeks), and the excretion of BK virus in the urine, as confirmed by electron microscopy, DNA hybridization and PCR analysis. Adenovirus was not involved. The serological assessment of BK virus-specific IgM and IgG pre- and post-BMT is consistent with viral reactivation in all patients, although a primary infection cannot be absolutely excluded in a single patient. A significant correlation between the use of high-dose busulphan (16 mg/kg) in the preparative regimen and development of haemorrhagic cystitis (P = 0. 0003) was evident. The severe course of the disease in two patients resulted in bladder tamponade; bleeding could not be inhibited with coagulation and laser treatment. Deterioration was prevented by bladder irrigation via a suprapubic catheter. Remission occurred spontaneously in all patients.
BK virus induced haemorrhagic cystitis in a paediatric bone marrow transplantation recipients is characterized by late onset, long duration, viral reactivation and correlates to high-dose busulphan. Severe bleeding could not be influenced by surgical intervention.
在1988年8月至1995年11月期间的117例骨髓移植（BMT）受者中，9例（7.7%）发生了出血性膀胱炎。所有9例患者的这种情况具有以下特点：发病较晚（BMT后第24天至第50天）、病程长（1至7周），并且通过电子显微镜、DNA杂交和PCR分析证实尿液中有BK病毒排出。未涉及腺病毒。BMT前后对BK病毒特异性IgM和IgG的血清学评估与所有患者的病毒再激活一致，尽管不能绝对排除单例患者存在原发性感染。预处理方案中使用大剂量白消安（16mg/kg）与出血性膀胱炎的发生之间存在显著相关性（P = 0.0003）。两名患者病情严重，导致膀胱填塞；凝血和激光治疗无法抑制出血。通过耻骨上导管进行膀胱冲洗可防止病情恶化。所有患者均自发缓解。
BK病毒引起的小儿骨髓移植受者出血性膀胱炎的特点是发病晚、病程长、病毒再激活，并且与大剂量白消安有关。手术干预无法影响严重出血。
