异基因造血干细胞移植后侵袭性真菌感染发生的临床特点及危险因素分析

目的 探讨恶性血液病异基因造血干细胞移植(allo-HSCT)后侵袭性真菌感染(IFI)的临床特点和影响移植后IFI发生与转归危险因素.方法 回顾性分析2001年1月至2008年12月193例单中心allo-HSCT患者移植后IFI发生率和转归,采用双变量相关分析和二分类Logistic回归分析方法,分别分析供者来源、HLA配型、干细胞来源、白细胞植入、移植前IFI病史和状态、移植物抗宿主病(GVHD)预防方案、急性与慢性GVHD对IFI发生和转归的影响.结果 移植后IFI 2年累计发生率为34.0%±4.0%,一级与二级预防突破性IFI发生率分别为3.8%与21.1%(P=0.000);84.2%患者IFI发生在移植后半年内;在可检测的病原菌中,霉菌与酵母菌分别为68.1%与27.7%;肺部与非肺部感染分别为84.2%与15.8%.IFI治疗总有效率为67.3%,其中完全缓解率为44.2%;移植后初发感染与复发患者对抗真菌药物的疗效比较统计学差异无显著性意义,IFI相关致死率为38.5%.多因素分析急性GVHD是影响IFI发生和转归的危险因素.结论 allo-HSCT后IFI以肺部霉菌最常见,有IFI病史患者不是allo-HSCT的绝对禁忌证,急性GVHD是影响IFI发生和转归的危险因素.

The clinical characteristic and risk factors for the incidence of invasive fungal infection in patients following allogeneic hematopoietic stem cell transplantation

Objective To approach the clinical characteristic and risk factors affecting the incidence and outcome of post-transplantation invasive fongal iafection (IFI) iu patients with malignant hematologic disease and undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The incidence and outcome of IFI after transplantation in 193 cases of recipients underwent allo-HSCT in our single center were assessed retrospectively.Some potential influential factors for that of IFI were analyzed by methods of bivariate correlate analysis and binary logistic regression analysis,including the source of donor and stem cell,human leukocyte antigen matched.white blood cell engraftment,the history and states of IFI before transplantation.prophylaxis schema for GVHD.acute and chronic GVHD.Results The 2-year cumulative incidence of post-transplantation IFI was 34.0%±4.0%.The incidences of breakthrough IFI at primary and secondary prophylaxis were 3.8% and 21.1%,respectively (P=0.003).84.2% patients with IFI occurred within half of years after transplantation.In fonts that can be measured,molds and yeasts accounted for 68.1% and 27.7%.respectively.Infective sites in pulmonary or not accounted for were 67.3% and 27.7%.respectively.The total effective rate of IFI was 67.3%,complete response rate was 44.2%.Furthermore,there was no statistically significant difierence in the therapeutic effect of antifungal agents between patients with a history of IFI and those without before transplantation.IFI-related mortality was 38.5%.Muti-variate analysis showed acute GVHD was an important factor affecting the incidence and outcome of IFI.Conclusion Pulmonary mold infection was the most common IFI after allo-HSCT.patients with a history of IFI did not seem to be an contraindication for allo-HSCT.Acute GVHD was a significant risk factor for the incidence and outcome of IFI.