Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
Ophthalmology. 2012 Sep;119(9):1892-8. doi: 10.1016/j.ophtha.2012.03.032. Epub 2012 May 30.
To evaluate the risk factors for cytomegalovirus (CMV) retinitis in patients with CMV viremia after hematopoietic stem cell transplantation (HSCT).
Retrospective cohort study.
We included all patients with CMV viremia detected by polymerase chain reaction after HSCT between April 2009 and August 2011. Risk factors for CMV retinitis were evaluated in the cohort of 270 patients with CMV viremia, who survived ≥ 12 weeks after HSCT and were screened for CMV retinitis.
Retrospective review of clinical records and laboratory results.
Survival analysis of patients in the cohort and frequency of CMV retinitis in relation to various factors. Variables analyzed were demographics, human leukocyte antigen (HLA) matched versus mismatched, related versus unrelated donor, preconditioning regimens, delayed engraftment of lymphocyte, presence of acute or chronic graft-versus-host disease, highest CMV DNA level in blood (copies/ml), cumulative period of CMV viremia (weeks), and CMV infection verified by culture or immunohistology in bronchoalveolar lavage or visceral biopsy specimens.
Of the 708 patients who underwent HSCT during the study period, 363 (51%) developed CMV viremia after HSCT. Of the 363 patients with CMV viremia, 270 underwent retinal examination for CMV retinitis. We detected CMV retinitis in 15 of 270 patients with CMV viremia. In the univariate analysis, HLA-mismatched HSCT, HSCT from an unrelated donor, engraftment day, peak CMV DNA level, and duration of viremia were associated with the development of CMV retinitis. In the adjusted multivariate analysis, only peak CMV DNA blood levels predicted the development of CMV retinitis (hazard ratio, 25.0; 95% confidence interval, 3.0-210.8). An additional validity analysis by receiver operating characteristic area under curve suggested that a cutoff of 7.64 × 10(4) copies/mL best predicted the development of CMV retinitis by CMV DNA levels in blood.
The development of CMV retinitis should be carefully monitored in patients with a significant viral load, which is represented by a peak CMV DNA level >7.64 × 10(4) copies/ml and a long duration of CMV viremia, especially when patients received HSCT from an unrelated or HLA-mismatched donor and showed delayed lymphocyte engraftment.
评估造血干细胞移植（HSCT）后巨细胞病毒（CMV）血症患者发生 CMV 视网膜炎的危险因素。
回顾性队列研究。
我们纳入了 2009 年 4 月至 2011 年 8 月期间通过聚合酶链反应检测到 CMV 血症的所有 HSCT 后患者。对 270 例 CMV 血症存活≥ 12 周并筛查 CMV 视网膜炎的患者进行了 CMV 视网膜炎危险因素评估。
回顾性分析临床记录和实验室结果。
对队列中患者的生存分析和与各种因素相关的 CMV 视网膜炎发生率。分析的变量包括人口统计学、HLA 匹配与不匹配、亲缘与非亲缘供者、预处理方案、淋巴细胞延迟植入、急性或慢性移植物抗宿主病、血中 CMV DNA 水平最高（拷贝/ml）、CMV 血症持续时间（周）以及支气管肺泡灌洗液或内脏活检标本中 CMV 培养或免疫组织化学证实的 CMV 感染。
在研究期间，708 例接受 HSCT 的患者中，363 例（51%）在 HSCT 后发生 CMV 血症。在 363 例 CMV 血症患者中，270 例行视网膜检查以筛查 CMV 视网膜炎。我们在 270 例 CMV 血症患者中发现 15 例患有 CMV 视网膜炎。在单因素分析中，HLA 不匹配 HSCT、非亲缘供者 HSCT、植入天数、CMV DNA 峰值和病毒血症持续时间与 CMV 视网膜炎的发生有关。在多因素调整分析中，只有 CMV 血中 DNA 峰值水平可预测 CMV 视网膜炎的发生（风险比 25.0；95%置信区间 3.0-210.8）。通过接受者操作特征曲线下面积的额外有效性分析表明，CMV 血症患者的 CMV DNA 水平在 7.64×10(4)拷贝/ml 以上时，CMV 视网膜炎的发生可以通过 CMV DNA 水平最佳预测。
当患者出现高病毒载量时，特别是在接受非亲缘或 HLA 不匹配供者的 HSCT 后出现淋巴细胞延迟植入的患者，应密切监测 CMV 视网膜炎的发生，高病毒载量表现为 CMV DNA 峰值>7.64×10(4)拷贝/ml 和 CMV 血症持续时间长。
