异基因造血干细胞移植后肺部侵袭性真菌感染现行诊断标准的应用价值  

The value of the current diagnostic criteria of pulmonary invasive fungal infection after allogeneichematopoietic stem cell transplantation

作　　者：沈建良[1] 宫立众[1] 刘代红[2] 黄晓军[2] 

机构地区：[1]海军总医院血液科,北京100048 [2]北京大学人民医院血液科北京大学血液病研究所

出　　处：《中华内科杂志》2013年第3期221-224,共4页Chinese Journal of Internal Medicine

摘　　要：目的分析我国现行血液病／恶性肿瘤患者侵袭性真菌感染诊断标准的可操作性，提高对异基因造血干细胞移植（allo—HSCT）后肺部侵袭性真菌感染特点的认识。方法回顾性分析连续收治的51例a110—HSCT后肺部侵袭性真菌感染病例的临床特点。结果肺部侵袭性真菌感染共占同期收治allo—HSCT后肺部感染病例的42．1％（51／121）。确诊1例（2．0％），临床诊断24例（47．1％），拟诊26例（51．0％）。使用免疫抑制剂、糖皮质激素和存在移植物抗宿主病为主要宿主因素。2种或2种以上宿主因素同时存在的病例占66．7％（34／51）。94．1％（48／51）病例的肺部高分辨cT表现为结节和（或）斑片影。真菌抗原检测阳性率相对较高[（1，3）-β-D葡聚糖（G）试验阳性率58．6％，半乳甘露聚糖（GM）试验阳性率33．3％]。20例（39．2％）患者伴有动脉血氧分压和氧饱和度下降。结论使用免疫抑制剂、糖皮质激素和存在移植物抗宿主病为主要宿主因素，肺部高分辨CT表现以结节和（或）斑片影多见，真菌抗原检测是支持临床诊断的主要因素。Objective To analyze the practicality of current diagnostic criteria of invasive fungal infection （IFI） in patients with hematologic diseases/malignant tumors, so as to enhance the recognition of characteristics of pulmonary IFI after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical features of 51 cases with IFI after allo-HSCT were analyzed retrospectively. Results Pulmonary IFI accounted for 42. 1% （51/121） of the whole infectious pneumonia diagnosed among the patients admitted during the study. One （2. 0% ） case was proven diagnosis;24 （47.1%） were probable diagnosis and 26（ 51.0% ） were possible diagnosis. The using of immuno-suppressors and corticosteroids, and the presence of graft-versus-host disease （GVHD） were the main host factors. The patients with two or more host factors simultaneously accounted for 66. 7% （ 34/51 ） of all pulmonary 1FI patients. Totally 94. 1% （48/51） of the patients with pulmonary IFI presented nodules and/or patches as the main features in high resolution computed tomography （HRCT） scanning. The positive rates of fungal antigen detection were 58.6% for G test and 33.3% for GM test, which were relatively high. Twenty patients （ 39. 2% ） showed decrease of arterial partial pressure of oxygen and hypoxia in blood-gas analysis. Conclusions For the diagnosis of pulmonary IFI post allo-HSCT, the administration of immuno-suppressors and corticosteroids, and the presence of GVHD were the main host factors. Nodules and/or patches were the main features in HRCT image. Fungus antigen detection is the main tool to support clinical diagnosis.

关 键 词：造血干细胞移植 诊断标准 侵袭性真菌感染 

分 类 号：R519[医药卫生—内科学]