Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
Biol Blood Marrow Transplant. 2012 Dec;18(12):1883-9. doi: 10.1016/j.bbmt.2012.07.005. Epub 2012 Jul 10.
Norovirus infections are increasingly being recognized as important causes of diarrhea in hematopoietic stem cell transplantation (HSCT) recipients. This retrospective study aimed to evaluate the cumulative incidence, risk factors, and outcomes of norovirus infection in pediatric HSCT recipients. Among 55 patients age <21 years who underwent first HSCT between July 2007 and June 2011, 49 patients developed diarrhea and had stool tested for norovirus. Eight of these patients were found to be infected with norovirus. All were sporadic cases and manifested with nausea, vomiting, and diarrhea. The median age of these patients was 5.2 years (range, 0.5-18.5 years). Six were males. Seven patients underwent unrelated donor HSCT, and 1 patient underwent autologous cord blood HSCT. Two patients had norovirus infection before HSCT that persisted after transplantation. In the remaining 6 patients, norovirus developed at a median of 36.5 days posttransplantation (range, 5-517 days). The cumulative incidence of norovirus infection was 12.9% at 2 years posttransplantation. Risk factors for norovirus infection included the use of peripheral blood or cord blood as the stem cell source (P = .043) and administration of fludarabine (P = .002) and alemtuzumab (P = .011). The median time to viral clearance was 145 days (range, 13-263 days). Four-year survival was similar in norovirus-infected patients and noninfected patients (56.3% versus 58.3%).
诺如病毒感染越来越被认为是造血干细胞移植（HSCT）受者腹泻的重要原因。本回顾性研究旨在评估儿科 HSCT 受者诺如病毒感染的累积发病率、危险因素和结局。在 2007 年 7 月至 2011 年 6 月期间接受首次 HSCT 的 55 名<21 岁的患者中，49 名患者出现腹泻并对诺如病毒进行了粪便检测。其中 8 名患者被发现感染了诺如病毒。所有这些患者均为散发病例，表现为恶心、呕吐和腹泻。这些患者的中位年龄为 5.2 岁（范围，0.5-18.5 岁）。6 名男性。7 名患者接受了无关供体 HSCT，1 名患者接受了自体脐带血 HSCT。2 名患者在 HSCT 前即存在诺如病毒感染，且在移植后持续存在。在其余 6 名患者中，诺如病毒在移植后中位 36.5 天（范围，5-517 天）时出现。移植后 2 年诺如病毒感染的累积发病率为 12.9%。诺如病毒感染的危险因素包括外周血或脐带血作为干细胞来源（P =.043）、使用氟达拉滨（P =.002）和阿仑单抗（P =.011）。病毒清除的中位时间为 145 天（范围，13-263 天）。诺如病毒感染患者和未感染患者的 4 年生存率相似（56.3%比 58.3%）。
