Torres Harrys A, Aguilera Elizabeth A, Mattiuzzi Gloria N, Cabanillas Maria E, Rohatgi Nidhi, Sepulveda Carmen A, Kantarjian Hagop M, Jiang Ying, Safdar Amar, Raad Issam I, Chemaly Roy F
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D.Anderson Cancer Center, Houston, TX, USA.
Haematologica. 2007 Sep;92(9):1216-23. doi: 10.3324/haematol.11300. Epub 2007 Aug 1.
Little is known about respiratory syncytial virus (RSV) infection in patients with leukemia. The aim of this study was to determine the characteristics, and the outcome of RSV infection with or without therapy with aerosolized ribavirin in leukemia patients.
We reviewed the records of 52 leukemia patients with RSV infection seen at our institution between October 2000 and March 2005.
The median age of the patients was 47 years (range, 1-83 years). Most patients were male (65%) and had acute leukemia (65%); 46% had received salvage chemotherapy and 62% corticosteroids before RSV infection. Compared to the 25 patients with upper respiratory tract infection (URI), the 27 patients with pneumonia had a higher median APACHE II score at the time of the first assessment at the hospital for respiratory symptoms (11 vs 16), and a higher rate of corticosteroid treatment in the month preceding the infection (48% vs 74%) (all p < or =0.05). Twenty-four (46%) patients received aerosolized ribavirin. Patients who presented with URI and were treated with ribavirin were less likely than non-treated patients to develop pneumonia (68% vs 96%, p<0.01) and possibly die of pneumonia (6% vs 36%, p=0.1). Multiple logistic regression analysis identified high APACHE II score and lack of ribavirin treatment as independent predictors of progression to pneumonia (p=0.01). Five patients (10%) died within 30 days of RSV infection; all had pneumonia.
RSV infection is associated with significant morbidity and mortality in leukemia patients; treatment with aerosolized ribavirin at the stage of URI may prevent pneumonia in some subsets of patients.
关于白血病患者呼吸道合胞病毒（RSV）感染的情况，人们了解甚少。本研究的目的是确定白血病患者RSV感染的特征，以及接受或未接受雾化利巴韦林治疗的RSV感染的转归。
我们回顾了2000年10月至2005年3月期间在我院就诊的52例白血病合并RSV感染患者的病历。
患者的中位年龄为47岁（范围1 - 83岁）。大多数患者为男性（65%）且患有急性白血病（65%）；46%的患者在RSV感染前接受过挽救性化疗，62%接受过皮质类固醇治疗。与25例上呼吸道感染（URI）患者相比，27例肺炎患者在因呼吸道症状首次入院评估时的APACHE II评分中位数更高（11对16），且在感染前一个月接受皮质类固醇治疗的比例更高（48%对74%）（所有p≤0.05）。24例（46%）患者接受了雾化利巴韦林治疗。出现URI并接受利巴韦林治疗的患者比未治疗患者发生肺炎的可能性更小（68%对96%，p<0.01），死于肺炎的可能性也可能更小（6%对36%，p = 0.1）。多因素逻辑回归分析确定，高APACHE II评分和未接受利巴韦林治疗是进展为肺炎的独立预测因素（p = 0.01）。5例（10%）患者在RSV感染后30天内死亡；均患有肺炎。
RSV感染在白血病患者中与显著的发病率和死亡率相关；在URI阶段使用雾化利巴韦林治疗可能会预防部分患者发生肺炎。
