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[造血干细胞移植后成年患者呼吸道合胞病毒感染的临床特征及死亡危险因素]

[Clinical characteristics and risk factors for death of respiratory syncytial virus infection in adult patients after hematopoietic stem cell transplantation].

作者信息

Li Y, Zhang F, Liu C, Zhao X S, Mo X D, Wang F R, Yan C H, Wang Z D, Kong J, Zhang Y Y, Zheng F M, Liu Y, Cao L Q, Deng D X, Huang X J, Zhang X H

机构信息

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing 100044, China.

Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2024 Oct 14;45(10):916-922. doi: 10.3760/cma.j.cn121090-20240424-00162.

Abstract

To summarize the clinical features associated with respiratory syncytial virus (RSV) infection in patients following the hematopoietic stem cell transplant (HSCT) and exploring the risk factors for death. Patients who had RSV infection after undergoing HSCT from October 2023 to January 2024 in the hematology department of Peking University People's Hospital were enrolled in the study. The clinical characteristics of the participating patients were summarized. The clinical characteristics of the surviving and the dying patients were compared, and the risk factors of death were analyzed by binary logistic regression. Among the 43 RSV-positive HSCT patients, 20 (46.5%) were hypoxemic, six (14.0%) were admitted to the ICU for further treatment, four (9.3%) required tracheal intubation assisted ventilation, and seven patients (16.3%) died. A comparison of the clinical features of the surviving patients and the deceased patients demonstrated that the deceased patients had a lower PLT when infected with RSV [74.5 (8.0-348.0) ×10(9)/L 15.0 (10.0-62.0) ×10(9)/L, =0.003], a higher incidence of simultaneous bacterial infections (85.7% 41.7%, =0.046), and a higher rate of hematological recurrence (71.4% 13.9%, =0.004). Hematological recurrence (=15.500, 95% 2.336-102.848, =0.005), influenza A viral infection (=14.000, 95% 1.064-184.182, =0.045), and low PLT at the time of RSV infection (=0.945, 95% 0.894-0.999, =0.048) were the factors associated with death following HSCT. Patients infected with RSV after undergoing HSCT have a poor prognosis, and active prevention and treatment of RSV in the autumn and winter requires urgent attention.

摘要

总结造血干细胞移植(HSCT)后患者呼吸道合胞病毒(RSV)感染的临床特征,并探讨死亡危险因素。纳入2023年10月至2024年1月在北京大学人民医院血液科接受HSCT后发生RSV感染的患者。总结参与患者的临床特征。比较存活患者和死亡患者的临床特征,并通过二元逻辑回归分析死亡危险因素。在43例RSV阳性的HSCT患者中,20例(46.5%)出现低氧血症,6例(14.0%)入住ICU进一步治疗,4例(9.3%)需要气管插管辅助通气,7例患者(16.3%)死亡。存活患者和死亡患者临床特征比较显示,死亡患者感染RSV时血小板计数较低[74.5(8.0 - 348.0)×10⁹/L对15.0(10.0 - 62.0)×10⁹/L,P = 0.003],同时合并细菌感染的发生率较高(85.7%对41.7%,P = 0.046),血液学复发率较高(71.4%对13.9%,P = 0.004)。血液学复发(P = 15.500,95%CI 2.336 - 102.848,P = 0.005)、甲型流感病毒感染(P = 14.000,95%CI 1.064 - 184.182,P = 0.045)以及RSV感染时血小板计数低(P = 0.945,95%CI 0.894 - 0.999,P = 0.048)是HSCT后死亡的相关因素。HSCT后感染RSV的患者预后较差,秋冬季积极预防和治疗RSV感染亟待关注。

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