异基因造血干细胞移植后肺炎的病因分析

目的:分析异基因造血干细胞移植后肺炎的临床特点和病因谱.方法:总结北京大学血液病研究所1998至2001连续4年中255例异基因造血干细胞移植受者中发生移植后肺炎的资料.结果:66例发生移植后肺炎的患者累计发病72例次,总发病率25.9%;50例患者的移植后肺炎被治愈,占75%.病因分析显示,细/真菌感染性移植后肺炎12例次(16.7%),巨细胞病毒性肺炎22例次(30.6%),特发性肺炎综合征36例次(50.0%).总死亡率为22.7%.发生特发性肺炎综合征的患者较多伴发慢性移植物抗宿主病,免疫抑制剂治疗有效.结论:异基因造血干细胞移植后肺炎是移植后常见的合并症,其病因学包括感染和非感染因素,针对病因的治疗可以改善预后.

Analysis of pathogenesis of pneumonia post allogeneic hematopoietic stem cell transplantation

Objective: To analyse the clinical features and pathogenesis of pneumonia post allogeneic hematopoietic stem cell transplantation (HSCT). Methods: Analysis was made of 255 patients of recipients of allo-HSCT from 1998 to 2001. Results: Seventy-two episodes of pneumonia occurred in 66 patients with the morbidity of 25.9%; 50 (75%) patients were cured. Twelve episodes (16.7%) were caused by mixed infection of bacteria and fungi;22 episodes (30.6%) were caused by cytomegalovirus infection and 36 episodes (50.0%) were classified as idiopathic pneumonia syndrome. The total mortility of pneumonia post allo-HSCT in our institute was 22.7%. The occurrence of chronic graft-versus-host disease was significantly high in idiopathic pneumonia syndrome, in which good response to immune suppressive therapy was observed. Conclusion: Pneumonia post allo-HSCT is a common complication, of which pathogenesis includes infection and non-infection. Its clinical outcome could be improved by specific therapy.