血清半乳甘露聚糖抗原检测对血液病患者侵袭性曲霉病的诊断及预后的价值

目的 初步评价动态检测血清半乳甘露聚糖(GM)抗原水平对血液病患者侵袭性曲霉病(IA)的诊断价值及疗效.方法 采用ELISA法连续检测172例白血病和进行造血干细胞移植或移植后患者的613份血清标本的GM浓度,GM试验阳性定义为连续2次不同时点检测A值>0.5或单次>0.7.对GM试验阳性的患者给予抢先抗曲霉治疗.结果 按照试验中界定的界值,该诊断试验的的灵敏度为81.1%,特异度为88.2%.GM测定阳性55例,阴性117例,通过GM测定临床诊断IA者由37例增加至52例,55例GM阳性患者38例完成针对曲霉的抢先治疗,26例有效,12例无效死亡,病死率为31.6%.抗曲霉治疗前GM 水平呈缓慢上升趋势,保持在较高水平;抗真菌治疗有效患者的GM 含量呈下降趋势,无效死亡患者中呈上升趋势.结论 血清GM 检测可以为早期诊断IA提供有力证据,动态监测GM值变化趋势是评价疗效的有用指标.     

血清半乳甘露聚糖水平检测对COPD患者侵袭性肺曲霉菌感染的诊断价值

目的探究血清半乳甘露聚糖水平检测对慢性阻塞性肺疾病（COPD）患者侵袭性肺曲霉菌感染（IPA）的临床意义。方法选取42例具有IPA高危因素的COPD患者,采用回顾性诊断标准进行分组：COPD确诊IPA 组、COPD可疑IPA 组和COPD排除IPA 组,比较三组的血清半乳甘露聚糖吸光度值。以确诊和排除 IPA 的患者作为阳性和阴性病例,分析血清半乳甘露聚糖水平检测在不同阳性判断临界值下的灵敏度与特异度。结果按照回顾性标准,COPD确诊IPA 组有18例、COPD可疑IPA 组有12例、COPD排除IPA 组有12例。三组患者的吸光度值分别为：1.69±0.87、1.38±0.79和0.27±0.60。 COPD确诊IPA 组与COPD可疑IPA 组的吸光度值均高于COPD排除IPA 组,差异均有统计学意义（t分别=4.92、4.01,P均＜0.05）,而COPD确诊IPA 组与COPD可疑IPA 组之间比较,差异无统计学意义（t=0.99,P＞0.05）。不同半乳甘露聚糖阳性界定值显示：当半乳甘露聚糖取0.7作为阳性界定值时,其对COPD合并 IPA 的诊断灵敏性、特异性、阳性预测值、阴性预测值分别为87.30%、96.50%、87.20%及96.50%。结论血清半乳甘露聚糖的检测对于COPD患者侵染肺曲霉菌感染有较好的检测诊断作用,但并不能有效的区分COPD患者合并IPA患者的诊断级数,并且当血清半乳甘露聚糖临界值为0.7时,对于COPD患者侵染肺曲霉菌感染有较高的诊断价值。     

半乳甘露聚糖检测对侵袭性曲霉病早期诊断的研究

目的评价酶联免疫吸附法(ELISA)连续检测血清半乳甘露聚糖(galactomannan,GM)抗原对侵袭性曲霉病(in-vasive aspergillosis,IA)早期诊断和疗效监测中的价值。方法92例白血病和造血干细胞移植(hematopoietic stem celltransplants,HSCT)患者纳入实验研究,共测定标本290份。采用ELISA方法检测血清中的GM,检测浓度可达到0.5ng/ml。结果以1.5为阳性界值,GM检测的敏感性为60%,特异性100%,诊断符合率88%;以0.8为阳性界值,敏感性为90%,特异性95%,诊断符合率94%。连续监测时GM可早于真菌培养方法2～20d预测曲霉感染。在GM阳性患者中,对13例病人进行抗曲霉治疗,10例有效,3例无效死亡。抗曲霉治疗前GM水平呈缓慢上升趋势,保持在较高水平,抗真菌治疗有效病人的GM含量呈下降趋势,无效死亡病人呈上升趋势。结论血清GM检测是对白血病和HSCT患者IA的早期诊断和疗效评价的有用指标。     

曲霉半乳甘露聚糖检测对侵袭性曲霉病早期诊断的实验研究

目的：评价酶联免疫吸附试验（ELISA）检测曲霉半乳甘露聚糖（GM）抗原对侵袭性肺曲霉病（IA）的诊断价值,确定合适的阳性界值（cut-off）及对诊断和治疗的指导意义。方法：采用ELISA方法检测87例IA高危患者的血清曲霉GM抗原,比较cut-off 1.5、cut-off 1.0、cut-off 0.5时GM检测的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）。结果：cut-off 1.5时,ELISA检测的敏感性、特异性、PPV、NPV分别为50%、96%、91%和71%;cut-off 1.0时分别为65%、92%、87%和77%;cut-off 0.5时分别为75%、88%、83%和81%。结论：曲霉菌半乳甘露聚糖抗原ELISA检测可用于临床诊断侵袭性曲霉菌感染,以0.5为折点对早期诊断很有意义,有利于高危患者曲霉感染病死率的降低。     

血清半乳甘露聚糖检测用于诊断侵袭性肺曲霉病的研究进展

侵袭性肺曲霉病（invasive pulmonary aspergillosis,IPA）指由曲霉引起的支气管肺部真菌感染,临床分为原发性和继发性。曲霉是自然界广泛存在的一类条件致病菌,约有600多种,其中对人类致病的约40种,最常见的是烟曲霉、黑曲霉和黄曲霉。当曲霉的分生孢子（2～3μg）被人体吸入后,直接入肺泡并生长发育,产生菌丝侵袭肺实质,其最终是否发病和发病类型取决于宿主是否患有严重的基础疾病及免疫状况。近年来由于造血干细胞移植（HSCT）、实体器官移植的广泛开展,高强度免疫抑制剂和大剂量化疗药物的应用以及各种导管的体内介入、留置等,临床上IPA的发病率明显上升。     

支气管肺泡灌洗液半乳甘露聚糖检测对侵袭性肺曲霉菌感染诊断价值的Meta分析

目的采用Meta分析评价酶联免疫吸附试验(ELISA)检测支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)诊断侵袭性肺曲霉菌病(IPA)的准确性和诊断临界值。方法检索Pub Med、EMBASE、Medline、中国期刊全文数据库(CNKI)、万方医学网等数据库,检索时间2007年5月至2013年2月,对符合纳入标准的15篇文献(包括22组数据)进行质量评价、异质性分析、合并效应量、受试者工作特征(ROC)曲线及不同临界值分析。结果BALF GM试验诊断IPA的合并敏感性为0.70(95%可信区间0.66~0.74),合并特异性为0.93(95%可信区间0.92~0.95),ROC曲线下面积为0.90(95%可信区间0.87~0.92),阳性似然比和阴性似然比分别为14、0.29。当临界值为0.5、0.8、1.0时,合并敏感性分别为0.75、0.69、0.68,合并特异性分别为0.89、0.94、0.96。结论从现有的文献来看,BALF GM试验诊断IPA具有较高的敏感性和特异性,当临界值为1.0时,BALF GM试验可以更有效地检出IPA,对临床具有辅助诊断价值。     

国内ELISA血清半乳甘露聚糖检测诊断侵袭性曲霉菌病价值的系统评价

目的系统评价当前国内酶联免疫吸附试验(ELISA)检测曲霉半乳甘露聚糖诊断侵袭性曲霉菌病文献的质量,分析偏倚和变异产生的来源,以及不同阳性临界值的诊断效能。方法计算机检索CBM、CNKI、VIP和万方数据库(1994.1～2010.11),及手工查阅获得研究人血清半乳甘露聚糖检测诊断侵袭性曲霉菌病的中文文献。由两名研究者按纳入排除标准进行资料提取,采用诊断性试验质量评价标准评价纳入文献质量后,用Meta Disc 1.4软件进行数据分析。通过汇总敏感度、特异度、汇总似然比及汇总受试者工作特征曲线(SROC曲线)等统计指标并计算曲线下面积AUC,选取最佳的阳性临界值。结果从2658篇文献中筛选出20篇符合纳入标准的研究,按不同的阳性临界值分组,异质性检验提示无阈值效应,但存在其他原因导致的异质性,采用随机效应模型进行Meta分析。结果显示:与其他组相比,CUT-OFF值取0.7组SROC曲线下面积AUC=0.9456,Q*=0.8846,其诊断真实性最好。结论 ELISA人半乳甘露聚糖检测用于临床诊断侵袭性曲霉菌感染,以单次0.7为折点对早期诊断很有意义,有利于降低高危病人曲霉感染病死率。     

血清1,3-β-D葡聚糖和半乳甘露聚糖检测对造血干细胞移植受者侵袭性真菌感染的诊断意义

目的:评价血清1,3-β-D葡聚糖(BDG)检测(G试验)和半乳甘露聚糖检测(GM试验)对造血干细胞移植(HSCT)受者侵袭性真菌感染(IFI)的诊断价值。方法:采用Platelia Aspergillus酶联免疫吸附试验(ELISA)试剂盒和GKT-5M Set动态真菌检测试剂盒对64例HSCT受者移植后每周2次同时进行血清GM试验和G试验,并根据欧洲癌症研究治疗组织/真菌病研究组(EORTC/MSG)的诊断标准定义临床诊断真菌感染病例,对两种检测方法的检测结果作ROC曲线分析,采用χ2检验对GM试验不同阳性阈值之间及GM与G试验之间诊断结果的一致性进行分析。结果:单次GMⅠ值>0.7和G试验BDG质量浓度>26.0pg/L分别为GM和G试验阳性折点时曲线下面积最大,两者灵敏度分别为87.0%、69.6%,特异度分别为92.7%%和85.4%。单次GMⅠ值>0.7与连续2次GMⅠ值>0.5的结果一致性较差(Kappa=0.308,P0.05)。结论:GM试验和G试验是诊断IFI可靠的诊断方法,两者对IFI临床诊断意义的一致性较好;采用一次试验检测时,选择GM试验更为理想,且以单次GMⅠ>0.7作为阳性阈值为佳。     

血清半乳甘露聚糖在侵袭性肺曲霉菌病中的临床意义

目的 分析血清半乳甘露聚糖（GM）在侵袭性肺曲霉菌病（IPA）中的临床意义。方法 收集2020年3月—2023年3月上海交通大学医学院附属第九人民医院160例拟诊IPA患者和同期30例行整形美容手术的无真菌感染者（阴性对照）痰液样本和血液样本。采用沙保弱培养基分离培养痰液样本中的真菌,检测患者血清GM水平。结果 160例拟诊IPA患者中,传统培养方法阳性77例（48.1%）,以烟曲霉为主（35.0%）,其次为黄曲霉（8.1%）。GM试验、真菌培养和二者联合诊断IPA的敏感性分别为68.2%、56.5%和96.5%。连续检测80例确诊IPA的患者抗真菌治疗后血清GM,其中72例血清GM水平逐渐降低至阴性（<0.75μg/L）。结论 临床有效的抗曲霉菌治疗能降低血清中GM的含量,连续检测血清GM水平有助于观察病情变化和治疗效果。     

造血干细胞移植患者人巨细胞病毒监测的临床意义

目的探讨荧光定量聚合酶链反应对造血干细胞移植患者人巨细胞病毒活动性感染的早期诊断价值。方法收集40例造血干细胞移植患者共416份血标本,应用实时荧光定量PCR方法动态监测血浆HCMV—DNA载量,并与60例健康体检者血浆HCMV—DNA载量对比分析。结果416份血标本中96份阳性,阳性率23．1％,病毒载量介于5．0x10^2-1．0x10,拷贝／ml之间。结论实时荧光定量PCR方法检测HCMV—DNA适用于造血干细胞移植后巨细胞病毒活动性感染的早期诊断。     

血清1,3-β-D-葡聚糖检测用于造血干细胞移植后患者侵袭性真菌感染诊断的界值初探

目的 评价血清1,3-β-D-葡聚糖(BG)浓度检测对我国造血干细胞移植(HSCT)后患者侵袭性真菌感染(IFI)早期诊断的意义并确定其界值.方法 按我国IFI的诊断标准,采用Glucatell试剂盒对HSCT后拟诊IFI的36例患者m清标本(每周采血2次)进行BG浓度的检测(G实验).根据临床回顾性诊断标准定义阳性和阴性病例,按不同G试验阳性标准计算其灵敏度、特异度,最终确定G试验在我国HSCT后患者IFI诊断的界值.结果 按试验中所得的单次结果≥80 ng/L或连续两次结果≥60ng/L作为界值,得出G试验的灵敏度、特异度、阳性和阴性预测值结果分别为81.0%、81.8%、89.5%和69.2%(P=0.002),并以此作为G试验在我国HSCT后IFI诊断的界值.结论 G试验在我国HSCT患者IFI诊断的界值与国外基本相同,是一种早期诊断IFI的快速、灵敏的检测.方法 ,值得临床推广.     

Adherence to outpatient oral medication regimens in adolescent hematopoietic stem cell transplant recipients

PurposeHematopoietic stem cell transplantation (HSCT) is an increasingly utilized treatment option for adolescents with many life-threatening diagnoses. Suboptimal adherence may result in compromised treatment effectiveness and increased risk of adverse medical outcomes.MethodThis study examined adherence patterns in six adolescents (ages 12–18) who had undergone HSCT. Demographic and clinical information were obtained from caregivers and via chart review. Electronic pill bottles (Medical Event Monitors, MEMS™) were used to track medication adherence. Daily, weekly, and monthly adherence as well as medication interruptions (periods of ≥24 h between doses) were calculated.ResultsParticipants took 73% of doses (SD = 13%) and demonstrated perfect adherence on 56% of days (SD = 18%, Range = 34–88%). Average monthly adherence ranged from 40 to 91% and decreased over time. Participants demonstrated at least two [M(SD) = 4.20(2.28)] medication interruptions. Individual adherence patterns included high sustained adherence, variable adherence, and delayed non-adherence.ConclusionsOverall, participants struggled to adhere to medication schedules, taking less than three-quarters of prescribed doses and demonstrating perfect adherence on fewer than four out of seven days per week. Adherence rates are similar to those observed in other pediatric populations and demonstrate the importance of routinely assessing adherence in adolescents who have undergone HSCT.     

Brief oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

We previously reported the efficacy of oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis. The purpose of this study was to evaluate whether the further shortening of the duration of oral cryotherapy could minimize its side effects while sparing its efficacy. Seventeen consecutive recipients of allogeneic hematopoieic stem cell transplant conditioned with high-dose melphalan in combination with fludarabine alone or with fludarabine and additional radiation were enrolled in the study. The severity of stomatitis was graded according to the National Cancer Institute—Common Toxicity Criteria. Patients were kept on oral cryotherapy shortly before, during, and for additional 30 min after the completion of melphalan administration (60-min oral cryotherapy). Patients who were also enrolled in our previous study received the same type of oral cryotherapy but for additional 90 min after the completion of melphalan administration (120-min oral cryotherapy), and they served as controls. Only 2 (11.8%) of 17 patients receiving 60-min oral cryotherapy and 2 (11.1%) of 18 patients receiving 120-min oral cryotherapy developed grade 2 or 3 stomatitis, respectively. The difference between groups was not statistically significant (P=0.677). The incidence of unpleasant symptoms such as chills and nausea during oral cryotherapy decreased significantly with 60-min oral cryotherapy, as compared with that associated with 120-min oral cryotherapy (P<0.01). These results suggest that 60-min oral cryotherapy is as effective as 120-min oral cryotherapy at preventing high-dose melphalan-induced stomatitis, and shorter treatment might have contributed to relieve patient discomfort during oral cryotherapy.     

Combating infections in hematopoietic stem cell transplant recipients

Infections with a diverse group of microorganisms remain the leading causes of morbidity and mortality after hematopoietic stem cell transplantation. Importantly, the epidemiology of infectious complications has shifted substantially with changes in antimicrobial prophylaxis, conditioning regimens and graft manipulation, such that invasive mould infections and late viral infections are now the over-riding concerns. New antivirals and antifungals have entered clinical practice and hold considerable promise for improved outcomes.     

Respiratory failure in the hematopoietic stem cell transplant recipient

The number of patients receiving hematopoietic stem cell transplantation (HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.     

造血干细胞移植患者腹部超声特点

目的 探讨血液病患者造血干细胞移植治疗后腹部超声特点及相关临床意义.方法 对51例接受造血干细胞移植患者进行常规腹部超声检查,观察腹腔脏器声像图变化.结果 同移植前比较,患者在移植后发生弥漫性肝实质损害、肝静脉纤细、胆囊壁增厚、胆汁淤积、脾体积缩小、肠蠕动异常及腹水等一系列变化,差异有显著性意义（P〈0.05）;而肝大小、肾实质损害、脾内部回声及胰腺变化则差异无显著性意义（P〉0.05）.结论 造血干细胞移植后患者常发生一系列腹腔脏器超声特征性变化,常规腹部超声检查能为移植相关并发症早期诊断提供及时、可靠的诊断依据.     

Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

Goals The purpose of this study was to evaluate the efficacy of oral cryotherapy to prevent high-dose melphalan-induced stomatitis.Patients and methods Eighteen consecutive recipients of allogeneic hematopoietic stem cell transplant conditioned with high-dose melphalan (140 mg/m²) in combination with fludarabine alone or with fludarabine and additional chemotherapy or radiation were enrolled. The severity of stomatitis was graded according to the National Cancer Institute Common Toxicity Criteria. Patients were kept on oral cryotherapy using ice chips and ice-cold water shortly before, during, and for additional 90 min after completion of melphalan administration.Results Only two of 18 patients (11.1%) developed grade 2 or 3 stomatitis while six of seven patients in the historical control developed it (85.7%; P=0.001).Conclusion These results suggested that oral cryotherapy could effectively prevent stomatitis caused by high-dose melphalan, and we recommend that it should be incorporated into the conditioning regimen with high-dose melphalan.     

碘附药浴用于造血干细胞移植患者体表皮肤消毒的效果

目的 比较氯己定药浴与碘附药浴两种方法用于造血干细胞移植患者体表皮肤消毒的效果.方法 将造血干细胞移植患者随机分为对照组和实验组各50例,对照组用0.05%氯己定溶液剂,药浴时间30min;实验组用0.05%碘附溶液剂,药浴时间15 min,两组水温42～44 ℃,观察右腋下、右外耳道、右鼻腔、脐周、右腹股沟、肛门共6个部位药浴后的病原菌数;眼部不适感例数;皮肤干燥发痒例数;药物刺激性呛咳例数;药浴溶液水温变化情况.结果 两组患者药浴后病原菌数阳性率比较差异无统计学意义（P＞0.05）;在眼部酸胀,眼部不适感;皮肤干燥发痒;药物刺激性呛咳方面差异有统计学意义（P＜0.05）;两组患者药浴15min和药浴30min时水温下降有显著性差别.结论 碘附药浴较氯己定药浴缩短了药浴时间,水温下降程度小,减轻了患者药浴的不适感,提高了舒适度.     

Safety of percutaneous dilational tracheostomy in hematopoietic stem cell transplantation recipients requiring long-term mechanical ventilation

Purpose

Recent reports have shown that the outcome of mechanically ventilated patients after hematopoietic stem cell transplantation (HSCT) has improved. This study was conducted to clarify if percutaneous dilational tracheostomy is safe in this group of patients and to report the outcome of HSCT recipients requiring long-term mechanical ventilation.

Methods

A retrospective review of our 8-year experience with patients with acute respiratory insufficiency after HSCT, requiring long-term mechanical ventilation and percutaneous dilational tracheostomy and an analysis of patient outcomes were made.

Results

Percutaneous dilational tracheostomy was safely performed in all 51 patients. Although 1 patient (2%) developed a pneumothorax that required drainage, stoma infections or severe bleeding complications were not observed. Of the 51 patients in the study, 14 (27%) survived the intensive care unit stay, and 10 of them were ventilated for more than 20 days. The intensive care unit survival rate for the period from 1998 to 2001 was 11% compared with 38% for the period from 2002 to 2005 (P = .053).

Conclusions

Percutaneous dilational tracheostomy can be safely performed on patients with acute respiratory failure after HSCT. This procedure did not result in postoperative wound infections or significant bleeding complications. Furthermore, the results of our study indicate that today even patients with prolonged mechanical ventilation (>20 days) have a chance of long-term survival.