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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (9): 96-99.doi: 10.6040/j.issn.1671-7554.0.2016.1024

• 临床医学 • 上一篇    下一篇

膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效

赵文博,甄长青,袁代,单宁宁,王娜,封丽丽,李沛沛,丁梅,李英,张凌岩,王欣   

  1. 山东大学附属省立医院血液科, 山东 济南 250021
  • 收稿日期:2016-08-19 出版日期:2017-09-10 发布日期:2017-09-10
  • 通讯作者: 王欣. E-mail:xinw007@126.com E-mail:xinw007@126.com
  • 基金资助:
    国家自然科学基金(81473486,81270598);国家公共卫生大研究基金会(201202017);山东省自然科学基金(ZR2012HZ003,2009ZRB14176);山东省科技攻关计划(2014GSF118021,2010GSF10250,2008GG2NS02018);山东省医学领军人才基金及泰山学者基金

Efficacy and safety of foscarnet in the treatment of hematonosis complicated with Epstein-barr virus infection

ZHAO Wenbo, ZHEN Changqing, YUAN Dai, SHAN Ningning, WANG Na, FENG Lili, LI Peipei, DING Mei, LI Ying, ZHANG Lingyan, WANG Xin   

  1. Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China
  • Received:2016-08-19 Online:2017-09-10 Published:2017-09-10

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摘要： 目的 探讨膦甲酸钠治疗血液病合并EBV感染患者,改善患者EBV血症的临床疗效、安全性及临床意义。 方法 回顾性分析2014年1月至2015年10月收治的血液病合并EBV感染患者112例,其中男70例,女42例,分为恶性血液病组(n=94例)和非恶性血液病组(n=18例),根据有无巨细胞病毒(CMV)感染以及是否接受骨髓移植治疗,恶性血液病组分为单纯EBV感染和合并CMV感染组,化疗组和骨髓移植组。以上患者均给予膦甲酸钠,60 mg/(kg·d),每12 h给药,每次静脉滴注至少3 h;疗程14 d,每周复查血常规、EBV病毒DNA定量和肝肾功,评价其治疗效果及不良反应。 结果 应用膦甲酸钠治疗血液病合并EBV感染患者总有效率72.3%,其中恶性血液病组有效率72.3%,非恶性血液病组有效率72.2%。 两组差异无统计学意义(P>0.05)。采用非参数秩和检验进行不同年龄、性别之间的疗效比较,各组差异无统计学意义(P>0.05)。在恶性血液病组中,合并CMV感染组疗效比单纯EBV感染组好,差异有统计学意义(P<0.05),而化疗组和骨髓移植组相比疗效差异无统计学意义(P>0.05)。治疗后各组患者EBV的DNA拷贝数有不同程度下降,用药达到有效中位时间为10.3~14.5 d。不良反应主要有恶心、心慌等症状,均可耐受。 结论 膦甲酸钠治疗血液病患者的EBV感染具有较好的有效性,不良反应较少,安全可耐受。

关键词: 膦甲酸钠, EBV感染, 血液病, 疗效

Abstract: Objective To investigate the efficacy of foscarnet in the treatment of hematonosis plus Epstein-barr virus(EBV)infection. Methods The clinical data of 112 cases of hematonosis complicated with EBV infection treated during Jan. 2014 and Oct. 2015 were retrospectively analyzed, including 70 males and 42 females. The patients were divided into malignant group(n=84)and non-malignant group(n=18). Based on the presence of cytomegalovirus(CMV)infection and bone marrow transplantation, the malignant group was subdivided into 4 groups: simple EBV group, EBV plus CMV group, chemotherapy group, and bone marrow transplantation group. All patients were given 山 东 大 学 学 报 (医 学 版)55卷9期 -赵文博,等.膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效 \=-foscarnet 60 mg/kg per 12 hours for 14 days. Peripheral blood samples were collected weekly for blood routine test, DNA quantity of EBV and liver-kidney function analysis, to evaluate the effect and adverse reactions of the treatment. Results The total effective rate was 72.3%, which was 72.3% and 72.2% respectively for the malignant group and non-malignant group, with no statistical difference(P>0.05). There was no statistically significant difference in the effective rate between male and female groups and different age groups(P>0.05). In the malignant group, EBV plus CMV group had higher effective rate than the simple EBV group, with statistically significant difference(P<0.05), while there was no difference between the chemotherapy group and bone marrow transplantation group(P>0.05). The copies of DNA of EBV decreased after treatment. The median time for effectiveness was 10.3 to 14.5 days. Adverse reactions such as nausea and palpitation were observed, but all were tolerable. Conclusion Foscarnet is safe and effective in the treatment of EBV infection in patients with malignant hematonosis, with a few tolerable adverse reactions.

Key words: Foscarnet, Epstein-Barr virus infection, Hematonosis, Therapeutic effect

中图分类号: 

  • R711
[1] Rafailidis PI, Mavros MN, Kapaskelis A, et al. Antiviral treatment for severe EBV infections in apparently immunocompetent patients[J]. J Clin Virol, 2010, 49(3): 151-157.
[2] 桂瑞瑞, 周健, 张艳莉, 等. EB病毒感染与恶性血液病相关性研究[J]. 中华实验和临床感染病杂志, 2012, 6(3): 16-18. GUI Ruirui, ZHOU Jian, ZHANG Yanli, et al. Association between Epstein-Barr virus infection and malignant hematologic diseases[J]. Chinese Journal of Experimental and Clinical Infectious Disease, 2012, 6(3): 16-18.
[3] Xuan L, Huang F, Fan Z, et al. Effects of intensified conditioning on Epstein-Barr virus and cytomegalovirus infections in allogeneic hematopoietic stem cell transplantation for hematological malignancies[J]. J Hematol Oncol, 2012, 5(1): 46.
[4] Sanz J, Arango M, Senent L, et al. EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases[J]. Bone Marrow Transplant, 2014, 49(3): 397-402.
[5] 韩婷婷, 许兰平, 刘代红, 等. 异基因造血干细胞移植后EB病毒感染情况分析[J]. 中华血液学杂志, 2013, 34(8): 651-654. HAN Tingting, XU Lanping, LIU Daihong, et al. Prevalence of EBV infection in patients with allogeneic hematopoietic stem cell transplantation[J]. Chinese Journal of Hematology, 2013, 34(8): 651-654.
[6] Rafailidis PI, Mavros MN, Kapaskelis A, et al. Antiviral treatment for severe EBV infections in apparently immunocompetent patients[J]. J Clin Virol, 2010, 49(3): 151-157.
[7] Chellapandian D, Das R, Zelley K, et al. Treatment of Epstein Barr virus-induced haemophagocytic lymphohistiocytosis with rituximab-containing chemo-immunotherapeutic regimens[J]. Brit J Haematol, 2013, 162(3): 376-382.
[8] Petropoulou AD, Porcher R, Peffault de Latour R, et al. Increased infection rate after preemptive rituximab treatment for Epstein-Barr virus reactivation after allogeneic hematopoietic stem-cell transplantation[J]. Transplantation, 2012, 94(8): 879-883.
[9] Fernández-Ruiz M, San-Juan R, Aguado JM. Epstein-Barr virus DNAemia and infectious complications after preemptive rituximab treatment[J]. Transplantation, 2013, 95(3): 13.
[10] Raymund RR. Antiviral Drugs for Viruses Other Than Human Immunodeficiency Virus[J]. Mayo Clin Proc, 2011, 86(10): 1009-1026.
[11] Coen DM, Schaffer PA. Antiherpesvirus drugs: a promising spectrum of new drugs and drug targets[J]. Nat Rev Drug Discov, 2003(2): 278-288.
[12] Bacigalupo A, Boyd A, Slipper J, et al. Foscarnet in the management of cytomegalovirus infections in hematopoietic stem cell transplant patients[J]. Expert Rev Anti Infect Ther, 2012, 10(11): 1249-1264.
[13] Schneider U, Ruhnke M, Delecluse HJ, et al. Regression of Epstein-Barr virus-associated lymphoproliferative disorders in patients with acquired immunodeficiency syndrome during therapy with foscarnet[J]. Ann Hematol, 2000, 79(4): 214-216.
[14] Oertel SH, Riess H. Antiviral treatment of Epstein-Barr virus-associated lymphoproliferations[J]. Recent Results Cancer Res, 2002, 159(159): 89-95.
[15] Ai Sato, Naoya Nakamura, Minoru Kojima, et al. Clinical outcome of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly in the rituximab era[J]. Cancer Sci, 2014, 105(9): 1170-1175.
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