儿童异基因造血干细胞移植后早期真菌感染的临床观察

目的探讨儿童异基因造血干细胞移植(Allo-HSCT)后使用伊曲康唑注射液预防早期真菌感染的疗效,并评价血浆真菌(1-3)-β-D-葡聚糖检测(G试验)的临床诊断价值。方法回顾性调查分析2008年3月~2011年2月南方医院儿科145例异基因造血干细胞移植术后早期真菌感染的发生情况。结果伊曲康唑注射液预防组及口服抗真菌药预防组的早期真菌感染率分别为5.50%和22.22%,两组早期死亡率分别为1.83%和11.11%,差异均有统计学意义(P0.05);伊曲康唑注射液副作用少。112例患儿进行了G试验,73例患儿结果阳性,其中3例为真菌感染病例;39例患儿结果阴性,其中1例为真菌感染病例;G试验对诊断真菌感染无统计学意义(P0.05)。结论伊曲康唑注射液能有效、安全地预防儿童allo-HSCT术后早期真菌感染。G试验在儿童allo-HSCT术后早期合并真菌感染诊断方面的应用价值有待进一步探讨。

Effect of traconazole on the prevention of fungal infection in children after allogeneic hemotoic stem cell transplantation

Objective To evaluate the clinical effect of itraconazole injection in prevention of early invasive fungal infections（IFIs）in children after allogeneic hemotoic stem cell transplantation（allo-HSCT）and to evaluate the value of plasma fungi（1-3）-β-D-glucan test（G test） in diagnosis of fungal infection in the childldren after allo-HSCT. Methods The clinical effect of prevention and treatment of early IFIs was retrospectively studied in 145 children post allo-HSCT from March1, 2008 to February 28, 2011.Results The incidence rate of IFIs in the itraconazole injection treatment group and the nonitraconazole treatment group were 5.50% and 22.22% respectively. There was a significant difference between the two groups（P 0.05）.The side effect of itraconazole was fewer.112 cases underwent a G test, and only 3 cases were proven fungal infection among 73 patients with positive result; 1 of 39 patients with negative result were proven fungal infection. There was no statistical significance for G test in diagnosis of fungal infection（P 0.05）. Conclusion Itraconazole injection is effective in prevention and treatment of early IFIs in children after allo-HSCT.