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An Experimental and Clinical Study of CMV Infection after Allogeneic Hematopoietic Stem Cell Transplantation

Author: WuXiaoJin
Tutor: WuDePei
School: Suzhou University
Course: Internal Medicine Hematology
Keywords: Allogeneic hematopoietic stem cell transplantation Cytomegalovirus Immunofluorescence Semi-nested PCR gb protein Genotyping CMV interstitial pneumonia GVHD
CLC: R512.99
Type: Master's thesis
Year: 2004
Downloads: 85
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Abstract


Purposes: (1) the establishment of a fast and reliable method of monitoring cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT); compare different detection methods on the value of early diagnosis of CMV infection. (2) study after allo-HSCT CMV the infected patients CMVgB protein genotyping and distribution and its relationship with CMV interstitial pneumonia and GVHD. Case methods: (1) from March 2001 to December 2003 our hospital allo-HSCT patients 74 cases. After transplantation, all patients with a semi-nested PCR in peripheral blood CMV-DNA detection, including 35 patients at the same time, compared with fluorescent immunohistochemical detection of peripheral blood CMV-PP65 antigen positive rate and the same rate for both. (2) observation of the different types of allo-HSCT patients with CMV infection status and CMV disease and treatment. (3) screened positive CMV-gB DNA and the amount of PCR product was digested enough patient specimens, Rsa Ⅰ and Hinf Ⅰ two restriction enzyme digestion genotyping analysis of patients with CMV infection gB protein genotype distribution and different genotypes with CMV interstitial pneumonia and GVHD. Results: (1) 74 patients were followed up for 90 to 720 days. The median time of 35 patients compared two methods for detecting fluorescent immunohistochemistry and semi-nested PCR method for the first time the detection of CMV viremia were 36 days and 26 days after transplantation, both persistently positive in The median time of 19 days and 28 days, there is a statistically significant difference (P <0.05). The both detected consistent rate of 88.57%, the detection rate was no statistically significant difference (P> 0.05). In the follow-up period, 35 patients two methods for detecting CMV-PP65 antigenemia and CMV-DNA hyperlipidemia incidence of 65.71% and 71.43%, respectively. (2) Non-myeloablative allogeneic peripheral blood stem cell transplantation (NST) of CMV infection rate was 78.95%, 48.57% the kinship between conventional transplant (R-BMT/R-PBSCT) CMV infection, unrelated donor bone marrow transplantation (UR-BMT) CMV infection rate was 61.54%, UR-BMT CMV allogeneic hematopoietic stem cell transplantation cytomegalovirus infection experiments and clinical studies Chinese feed rate of infection is higher than the kinship between conventional transplant, but there was no significant statistical learning differences (P gt; 0.05), NST CMV infection Phylogenetic conventional transplant was a statistically significant difference (p lt; 0.05), UR a BMT was no statistically significant difference (P gt; 0.05) In addition 7 cases (100%) haploid hematopoietic stem cell transplantation (several HSCT) in patients with CMV DNA and CMV PP65 are positive. (3) 47 (63.51%) in patients with CMV infection, in addition to patients to refuse treatment, I underwent interventional treatment intervention negative patients, 12 cases in 2 weeks to 6 months after the occurrence of CMV re-infection. CMV disease occurred in 20/74 cases (27.03%) patients, the median time of 65 days, seven cases (35%) died. (4) 38 cases of patients with CMV infection were digested, digested typing: type I (gBI) 19/38 cases (50.0%), 11 type (gBZ) 3/38 cases (7.89%), type 111 ( gB3) 14/38 cases (36.84%), and unknown sub-type 2/38 cases (5.27%). 111 patients with high incidence of CMV interstitial pneumonia symptoms; work in patients with a low incidence of CMV interstitial pneumonia, mild symptoms, both statistically significant difference between Iraq lt; 0.01), but I and 111 patients with GVHD There was no significant statistical difference (household 0 .05) O conclusions: (1) fluorescent immunohistochemistry and semi-nested PCR methods are an important means to detect allo early CMV infection after HSCT, both good consistent rate, However, the semi-nested PCR is more sensitive. (2) alfo high incidence of CMV infection after HSCT after allo-HSCT, different types of CMV infection rate may differ. (3) alfo CMV infection after HSCT patients gB protein genotype distribution differences. (4) CMV hundred protein genotyping and CMV interstitial pneumonia occurred about no significant correlation with the occurrence of GVHD.

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