79例异基因造血干细胞移植术后患者侵袭性真菌感染的分析  

Risk Factors and Outcome of Invasive Fungal Infection in 79Patients Received Allogeneic Hematopoietic Cell Transplantation

作　　者：倪明[1] 陈宝安[1] 何君[1] 丁家华[1] 程坚[1] 赵刚[1] 

机构地区：[1]东南大学医学院附属中大医院血液科(江苏医学重点学科),江苏南京210009

出　　处：《中国实验血液学杂志》2015年第2期485-489,共5页Journal of Experimental Hematology

基　　金：江苏省科技厅医学重点项目(BL2014078);江苏省医学重点学科(2011-12)

摘　　要：目的:了解患者行异基因造血干细胞移植术(HSCT)后发生侵袭性真菌感染(IFI)的发病率、危险因素及转归情况。方法:选择我院2005年1月至2014年9月进行HSCT的79例资料较完整的血液病患者的临床资料进行回顾性分析,分析HSCT患者发生IFI的临床特征、危险因素和转归。结果:诊断IFI患者共计17例,其中临床诊断者13例,拟诊4例。感染发生的中位时间为移植后112 d(9-1931 d)。非感染组及感染组的非复发生存率分别为61.2%、35.2%。根据单因素分析:配型、Ⅱ-Ⅳ度a GVHD是发生IFI的危险因素,性别、原发病、感染前使用糖皮质激素的量是患者发生死亡的危险因素。多因素分析显示配型、Ⅱ-Ⅳ度a GVHD是发生IFI的危险因素,感染前使用糖皮质激素量是患者发生死亡的危险因素。结论:具有多种危险因素的患者更易发生IFI,感染前使用较大剂量的免疫抑制剂者更易发生死亡。避免危险因素及回顾患IFI前30 d内使用免疫抑制剂情况可使患者有较好的预后。Objective： To study the incidence, risk factors and outcome of invasive fungal infection （IFI） in the recipients with allogeneic hematopoietic cell transplantation（HSCT）. Methods： 79 cases received HSCT in our hospital from January 2005 to November 2014 with complete data were analyzed retrospectively according to the diagnostic criteria of IFI. the clinical features, risk factors and outcome of IFI were investigated and analysed. Results： 17 cases of IFI were diagnosed, among them 13 cases were defined in clinic and 4 cases were possible. The median time of IFI occurence was 112 days（9 -1931 d）. The recurrence-free survival rate in non-infection and infection groups were 61.2% and 35.2% respectively. By single-factor analysis, the matching, II and IV degree of aGVHD were the risk factors of IFI, and the sex, protopathy, glucocorticoid used before infection were the risk factors of the death outcome. Multivariate analysis may indicated that the matching, Ⅱ-Ⅳ degree of aGVHD and glucocorticoid used before infection were associated with IFI and outcome. Conclusion： The patients received HSCT and having many risk factors are more likely predisposed to IFI. A greater dose of glucocorticoid used before infection is more likely to results in death, morever avoiding the risk factors may reduce the incidence of IFI, and the retrospecion of immunosupperssor dose used within 30 days before infection may improve proznosis.

关 键 词：异基因造血干细胞移植术 侵袭性真菌感染 

分 类 号：R457.7[医药卫生—治疗学]