异基因造血干细胞移植侵袭性真菌感染26例临床分析

目的 探讨异基因造血干细胞移植患者发生侵袭性真菌感染的高危因素、临床特点、治疗和预后.方法 分析我科2002年3月至2010年7月行造血干细胞移植术100例患者发生侵袭性真菌感染26例患者的临床资料.造血干细胞移植前发生肺部真菌感染7例;造血干细胞移植后发生肺部真菌感染14例,呼吸道真菌感染3例,肠道真菌感染2例.观察侵袭性真菌感染患者的移植物抗宿主病的发生、巨细胞病毒血症发生、淋巴细胞亚群检测、合并其他慢性基础疾病情况.将侵袭性真菌感染患者分为2组,拟诊经验性治疗组12例及临床诊断抢先治疗组14例.结果 26例侵袭性真菌感染的患者合并移植物抗宿主病20例,合并巨细胞病毒血症6例,细胞免疫功能低下的19例.合并糖尿病5例,肺结核3例,支气管扩张1例.经验性治疗组完全治愈8例(67%),疾病进展1例(8%).抢先治疗组完全治愈3例(21%);疾病进展5例(36%),2组比较差异有统计学意义(χ2=5.418,P<0.05).结论 造血干细胞移植存在侵袭性真菌感染高危因素的患者更应引起临床医师高度的重视.

Abstract：

Objective To explore the high-risk factors,clinical characteristics,therapy and prognosis of invasive fungal infection (IFI)in patients underwent allogeneic haemopoietic stem cell transplantation (AlloHSCT). Methods One hundred patients underwent Allo-HSCT at our department from March 2002 to July 2010 were analyzed retrospectively,among whom 26 patients had invasive fungal infection(IFI). Seven patients had pulmonary IFI before allo-HSCT, 14 patients had pulmonary IFI after allo-HSCT,3 patients had respiratory tract system IFI, and 2 patients had intestinal IFI. We observed the occurrence of Graft-versus-host disease (GVHD) ,cytomegalovirus( CMV )infection, Lymphocyte subsets and chronic basic diseases in patients with IFI. The twenty six cases were divided into two groups: experience therapy group with 12 cases and preemption therapy group with 14 cases. Results Among 26 patients with IFI,20 cases suffered from GVHD,6 cases had CMV infection,19 cases had low cellular immune function simultaneously. 1 case had diabetes,3 patients had pulmonary tuberculosis and 1 case had bronchiectasis as complications. In experience therapy groupe: 8 cases (67%)recovered completely but 1 case(8% )suffered from progressive infection. In preemption therapy groupe:3 cases ( 21% ) recovered completely but 5 cases ( 36% ) suffered from progressive infection. Conclusion Clinician should pay close attention to the patients with high-risk factors of IFI after allo-HSCT.

Clinical analysis of 26 patients with invasive fungal infection after allogeneic haemopoietic stem cell transplantation

Objective To explore the high-risk factors,clinical characteristics,therapy and prognosis of invasive fungal infection (IFI)in patients underwent allogeneic haemopoietic stem cell transplantation (AlloHSCT). Methods One hundred patients underwent Allo-HSCT at our department from March 2002 to July 2010 were analyzed retrospectively,among whom 26 patients had invasive fungal infection(IFI). Seven patients had pulmonary IFI before allo-HSCT, 14 patients had pulmonary IFI after allo-HSCT,3 patients had respiratory tract system IFI, and 2 patients had intestinal IFI. We observed the occurrence of Graft-versus-host disease (GVHD) ,cytomegalovirus( CMV )infection, Lymphocyte subsets and chronic basic diseases in patients with IFI. The twenty six cases were divided into two groups: experience therapy group with 12 cases and preemption therapy group with 14 cases. Results Among 26 patients with IFI,20 cases suffered from GVHD,6 cases had CMV infection,19 cases had low cellular immune function simultaneously. 1 case had diabetes,3 patients had pulmonary tuberculosis and 1 case had bronchiectasis as complications. In experience therapy groupe: 8 cases (67%)recovered completely but 1 case(8% )suffered from progressive infection. In preemption therapy groupe:3 cases ( 21% ) recovered completely but 5 cases ( 36% ) suffered from progressive infection. Conclusion Clinician should pay close attention to the patients with high-risk factors of IFI after allo-HSCT.