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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。
Objective To investigate the clinical efficacy, safety and clinical significance of foscarnet in the treatment of EBV infection in patients with hematological disease and EBV infection. Methods A retrospective analysis of 112 patients with EBV infection from January 2014 to October 2015 was conducted in 70 males and 42 females, which were divided into hematologic malignancies (n = 94) and non-hematologic malignancies (N = 18). According to the presence or absence of cytomegalovirus (CMV) infection and whether they received bone marrow transplantation, the hematologic malignancies were divided into simple EBV infection and CMV-infected group, chemotherapy group and bone marrow transplantation group. The patients were given foscarnet sodium 60mg / (kg · d), every 12 h dosing, each intravenous infusion of at least 3 h; course of treatment 14 d, weekly review of blood routine, EBV virus DNA quantification and liver and kidney function, Evaluation of the treatment effect and adverse reactions. Results The total effective rate of patients with hematological disease complicated with EBV infection was 72.3%. The effective rate was 72.3% in hematological malignancies and 72.2% in non-hematological malignancies. There was no significant difference between the two groups (P> 0.05). Nonparametric rank sum test was used to compare the curative effect of different age and gender. There was no significant difference among the groups (P> 0.05). In hematologic malignancy group, the curative effect of combined CMV infection group was better than that of pure EBV infection group, the difference was statistically significant (P <0.05), while there was no significant difference between chemotherapy group and bone marrow transplantation group (P> 0.05) . EBV DNA copy number of patients in each group after treatment decreased to varying degrees, medication to achieve an effective median time of 10.3 ~ 14.5 d. Adverse reactions are mainly nausea, palpitation and other symptoms, can be tolerated. Conclusion Foscarnet sodium in patients with hematological diseases EBV infection has good effectiveness, fewer adverse reactions, safe and tolerable.