Gluckman E, Traineau R, Devergie A, Esperou-Bourdeau H, Hirsch I
Bone Marrow Transplant Unit, Hôpital Saint-Louis, Paris, France.
Ann Hematol. 1992 Jun;64 Suppl:A158-61. doi: 10.1007/BF01715372.
CMV infection is the major infectious complication following bone marrow transplantation. It is most often related to reactivation of latent infection in patients who were CMV seropositive before BMT. The incidence and severity have recently been modified by the use of preventive and curative treatments. Prevention of CMV infection with the transfusion of seronegative blood products is useful only when donor and recipient are seronegative. High-dose acyclovir has been shown effective in one randomized study. A multicenter study is currently being performed in Europe to confirm this result. Intravenous gammaglobulins seemed to lower the number of patients who incur interstitial pneumonitis but not the incidence of viremia. They also decreased the incidence of gram-negative sepsis and severe GVH and improved survival. The treatment is based on the use of gancyclovir. Several studies show that gancyclovir is more effective in asymptomatic patients with viral isolation from blood or bronchoalveolar lavage. The addition to gancyclovir of high-dose gammaglobulin improves survival in symptomatic patients with interstitial pneumonitis. This progress in the prevention and treatment of CMV infection has improved the overall results of allogeneic bone marrow transplantation.
巨细胞病毒（CMV）感染是骨髓移植后主要的感染性并发症。它最常与骨髓移植前CMV血清学阳性患者的潜伏感染再激活有关。最近，通过使用预防性和治疗性措施，其发病率和严重程度已有所改变。仅当供体和受体均为血清学阴性时，输注血清学阴性血液制品预防CMV感染才有效。一项随机研究表明高剂量阿昔洛韦有效。欧洲目前正在进行一项多中心研究以证实这一结果。静脉注射丙种球蛋白似乎可减少发生间质性肺炎的患者数量，但不能降低病毒血症的发生率。它们还降低了革兰氏阴性菌败血症和严重移植物抗宿主病（GVH）的发生率，并提高了生存率。治疗基于使用更昔洛韦。多项研究表明，更昔洛韦对血液或支气管肺泡灌洗中分离出病毒的无症状患者更有效。在更昔洛韦基础上加用高剂量丙种球蛋白可提高有症状的间质性肺炎患者的生存率。CMV感染预防和治疗方面的这一进展改善了异基因骨髓移植的总体效果。
