造血干细胞移植后粒细胞缺乏期间感染的临床分析  

A clinical analysis of infection during agranulocytosis period after hematopoietic stem cell transplantation

作　　者：张苗[1] 孙自敏[1] 刘会兰[1] 高珊[1] 

机构地区：[1]安徽医科大学附属省立医院血液科,合肥230001

出　　处：《安徽医科大学学报》2013年第10期1278-1280,共3页Acta Universitatis Medicinalis Anhui

基　　金：安徽省"十二五"科技攻关项目(编号:11010402164)

摘　　要：造血干细胞移植（HSCT）治疗恶性血液病患者132例，其中血缘关系的异基因造血干细胞移植43例；非血缘异基因外周血造血干细胞移植1例；非血缘脐血移植（UCBT）82例；自体造血干细胞移植6例。移植前采用清髓性预处理方案126例，减低强度预处理方案6例。采用环孢素A（CsA）联合吗替麦考酚酯（MMF）预防移植物抗宿主病（GVHD）。结果显示，132例HSCT后粒细胞缺乏期间92例发生感染，感染率为69．7％，首次感染出现的中位时间为移植后6（移植前3d-移植后27d）d，感染最多见于移植后4d出现；感染发生的部位：以血流感最常见，血培养阳性率为28．3％，其中G-菌占67．9％，产超广谱β-内酰胺酶（Es—BL）菌阳性率为84．2％，G＋菌占32．1％，耐甲氧西林葡萄球菌（MRSA）阳性率为100％，G’菌均为万古霉素敏感菌。全部感染患者使用抗菌药物治疗有效率为93．5％，其中以碳青霉烯类联合氨基糖苷类治疗效果最佳，26．1％的患者使用经验性抗真菌药。132 consecutive patients with hematological malignancies were treated with HSCT. Among them,43 ca- ses received related allogeneic HSCT, 1 case unrelated allogeneic peripheral blood HSCT, 82 cases unrelated cord blood transplantation （UCBT） , and 6 eases autologous HSCT . Myeloablative conditioning was given to 126 cases and non-myeloablative regimens to 6 cases. All patients were given a combination of cyclosporine A（CsA） and myeophenolate mofetil （MMF） for graft-versus-host disease （GVHD） prophylaxis. 92 infectious episodes were registered from 132 patients during agranulocy.tosis period after HSCT. The incidence rate of infection was 69.7%. The first infection was usually observed on the 6th day after HSCT. The common infectious sites were bloodstream infec- tions and blood culture positive was 28.3%, The pathogen testing showed that 67.9% was Gbacteria and 32. 1% was G＋ bacteria. All G ＋ were sensitive vancomycin. For all patients treated with antibiotic therapy effective rate was 93.5 % , among which carbapenems combined aminoglycoside were the best, and 26. 1% of the patients used empiric antifungal drug.

关 键 词：造血干细胞移植 粒细胞缺乏 感染 

分 类 号：R551[医药卫生—血液循环系统疾病]