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目的探讨儿童再生障碍性贫血(AA)造血干细胞移植(HSCT)后并发播散型带状疱疹的诊断、高危因素、预防及治疗措施。方法回顾性分析2014年12月至2015年9月中山大学孙逸仙纪念医院儿科收治的3例AA患儿接受全相合非血缘相关供者HSCT后予免疫抑制剂治疗期间出现播散型带状疱疹的临床资料。结果 3例患儿年龄分别为13、12和10岁,移植后未出现移植物抗宿主病,予抗病毒药物单药预防水痘-带状疱疹病毒(VZV)期间均未出现VZV再激活,在HSCT后4.0、5.5和8.0个月停用抗病毒药物,分别在停用抗病毒药物后13.0、10.5和3.0个月出现皮肤播散型带状疱疹,予静脉更昔洛韦联合口服伐昔洛韦及外用喷昔洛韦抗病毒治疗至皮疹结痂,并予丙种球蛋白治疗,均完全治愈。结论接受HSCT的AA患者是播散型带状疱疹的高发人群,其发病率高、病情严重且病死率高。移植后予预防性抗病毒处理,出现播散型带状疱疹时减少免疫抑制剂量,联合更昔洛韦、伐昔洛韦及丙种球蛋白治疗,可明显改善疗效。
Objective To investigate the diagnosis, risk factors, prevention and treatment of disseminated shingles after hematopoietic stem cell transplantation (HSCT) in children with aplastic anemia (AA). Methods A retrospective analysis of three cases of AA children admitted to Sun Yat-sen Memorial Hospital, Sun Yat-sen University from December 2014 to September 2015 was performed on immunosuppressants with disseminated herpes zoster clinical information. Results The three children were 13, 12 and 10 years of age respectively. No graft-versus-host disease occurred after transplantation. VZV reactivation did not occur during the single anti-viral drug treatment of varicella-zoster virus (VZV) Antiviral drugs were discontinued at 4.0, 5.5 and 8.0 months after HSCT, skin-disseminated shingles appeared at 13.0, 10.5 and 3.0 months after antiviral therapy was discontinued, and intravenous ganciclovir combined with oral valacyclovir Wei and topical penciclovir antiviral therapy to rash and scab, and gamma globulin treatment were completely cured. Conclusions AA patients receiving HSCT are high incidence of disseminated shingles, with high incidence, serious illness and high mortality. After transplantation to preventative antiviral treatment, the emergence of disseminated herpes zoster to reduce immunosuppressive doses, combined with ganciclovir, valacyclovir and gamma globulin treatment can significantly improve the efficacy.