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造血干细胞移植受者病毒感染的预防

Author
John R Wingard, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD
Translators
王颖, 副主任医师，副教授

引言

造血干细胞移植(hematopoietic cell transplant, HCT)受者，尤其是接受异基因移植的患者，发生多种感染的风险会增加，这取决于免疫抑制程度和暴露情况。“HCT”这一术语在本篇专题中将用作一个统称，包括任何来源(如骨髓、外周血、脐带血)的祖细胞移植。 (参见“造血干细胞的来源”)

HCT受者感染会带来较高的并发症发病率和死亡率。对HCT受者具有重要意义的病毒包括单纯疱疹病毒(herpes simplex virus, HSV)、水痘-带状疱疹病毒(varicella-zoster virus, VZV)、巨细胞病毒(cytomegalovirus, CMV)、EB病毒(Epstein-Barr virus, EBV)、呼吸道病毒[如流感病毒、副流感病毒、呼吸道合胞病毒(respiratory syncytial virus, RSV)、腺病毒]、人类疱疹病毒6型(human herpes virus 6, HHV-6)、乙型肝炎病毒(hepatitis B virus, HBV)和丙型肝炎病毒(hepatitis C virus, HCV)。对于HCT受者，推荐对其中一些病毒进行抗病毒预防或抢先治疗，相关内容将在此讨论。HCT后感染的概述、HCT前感染的评估、HCT受者其他感染的预防以及HCT候选者和受者的免疫接种请参见其他专题。 (参见“造血干细胞移植后感染概述”和“造血干细胞移植前的感染评估”和“造血干细胞移植受者感染的预防”和“成人造血干细胞移植受者侵袭性真菌感染的预防”和“高风险成人化疗诱导中性粒细胞减少期间的感染预防”和“造血干细胞移植候选者和移植受者的免疫接种”)

指南

2009年发表了有关预防HCT后感染并发症的指南，该指南由欧洲和北美数个组织合作提出，其中包括欧洲血液和骨髓移植小组、美国血液和骨髓移植学会、加拿大血液和骨髓移植小组、美国感染病学会以及美国疾病预防控制中心[1]。我们的推荐通常与这些指南保持一致。

美国国家综合癌症网络还发布了关于癌症相关感染预防和治疗的指南[2]。

HCT前的评估

移植前评估的目的是通过排除不合适的供者以及确定具体感染控制策略及抗微生物预防和治疗方案(这在移植后也是必要的)，以预防移植后的感染。进行针对既往感染暴露证据的实验室检查，以便检测出HCT供者或候选者的无症状感染。一些检查推荐用于所有HCT供者和候选者，而另一些检查适用于具有流行病学危险因素的特定个体(表 1)[1,3]。血清学检查结果可提示显著既往暴露。

                                                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-10.
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