儿童异基因造血干细胞移植术后感染的实验观察

目的了解儿童异基因造血干细胞移植的感染率和特点。方法对上海儿童医学中心从2002年11月到2004年8月共18例异基因造血干细胞移植的血液肿瘤患儿,发生移植后感染的所有病例进行回顾性分析。结果18例异基因造血干细胞移植患儿,发生细菌、真菌感染的13例,感染率为72·2%;在28株分离菌中,革兰阳性菌14株,革兰阴性菌8株和真菌6株。主要细菌为凝固酶阴性葡萄球菌、肠球菌属、大肠埃希氏菌和克雷伯菌属,且大多数细菌耐药。实时定量PCR监测移植后人类巨细胞病毒(HCMV)感染发现:有16例患儿发生至少一次的HCMV感染,感染率为88·9%。结论感染是儿童异基因造血干细胞移植术后主要的并发症,临床早期诊断、定期监测、及时地合理治疗对降低移植术后感染和提高移植成功率至关重要。

Preliminary study on infection after childhood allogeneic hematopoietic stem cell transplantation

Objective To investigate infective rate and characteristics after childhood allogeneic stem cell transplantation. Methods A retrospective study of 18 childhood haematological tumor patients receiving allogeneic hematopoietic stem cell transplantation in our hospital from November 2002 to August 2004, was carried out. Results Bacterial and fungal infection occurred in 13 patients and infective rate was 72.2%(13/18). Of 28 strains isolated, 14 strains were Gram-positive bacteria, 8 strains were Gram-negative ones and 6 strains were fungi. The major bacteria were coagulase-negative staphylococci; Enterococcus spp; E. coli and Klebsiella spp; and most were drug resistant. 16 patients(88.9%)had at least one episode of HCMV infection, which was monitored by real-time quantitative PCR. Conclusions Infection is a major complication after childhood allogeneic hematopoietic stem cell transplantation. Early diagnosis, monitoring and using antibiotics correctly is very important to decreasing the infection after transplantation.