中性粒细胞输注的现状及发展方向  

Current situation and development of granulocyte transfusion

作　　者：范玉萍 滕燕 任仟 罗鸿博 马凤霞 FAN Yuping;TENG Yan;REN Qian;LUO Hongbo;MA Fengxia(State Key Laboratory of Experimental Hematology,Institute of Hematology and Blood Diseases Hospital,Chinese Academy of Medical Sciences,Tianjin 300020,China)

机构地区：[1]中国医学科学院血液病医院血液学研究所实验血液学国家重点实验室

出　　处：《中国输血杂志》2019年第12期1286-1291,共6页Chinese Journal of Blood Transfusion

基　　金：天津市自然科学基金(18JCYBJC25700);中国医学科学院医学与健康科技创新工程(2016-I2M-1-017,2017-I2M-1-015);中国医学科学院中央级公益性科研院所基本科研业务费(2017PT31033,2018RC31002,2018PT32034)

摘　　要：中性粒细胞缺乏(粒细胞缺乏)是造血干细胞移植和肿瘤患者放、化疗后的常见并发症,患者极易发生细菌和真菌感染。目前,临床治疗粒细胞缺乏诱发的感染的主要方式是应用广谱的抗细菌和真菌药物,对于抗菌药物耐药或粒细胞缺乏严重的患者,粒细胞输注(GTX)可作为1项辅助的治疗措施。尽管很多临床前和临床研究显示GTX有助于清除感染,提高患者生存率;但是最新的多中心随机对照研究认为GTX的有效性以及适用的患者仍然不明确。随着新型抗细菌和真菌药物的研发和应用,以及粒细胞集落刺激因子(G-CSF)帮助缩短粒细胞缺乏持续时间,GTX治疗感染的临床应用面临前所未有的挑战。本综述将总结近10年来国内外GTX的临床应用现状,研究者为明确GTX的剂量、时机、适应证和确切疗效与提高GTX治疗效果所做的努力,并讨论GTX的发展方向和前景。Neutropenia is a common complication of chemotherapy,radiotherapy and hematopoietic stem cell transplantation,which are extensively used to treat tumors.Patients with neutropenia are liable to severe bacterial and fungal infection whichgreatly leaded to high mortality and morbidity.Broad spectrum anti-bacterial and anti-fungal drugs are used to treat neutropenia related infections.However,not all patients respond toantibiotic treatment.Granulocyte transfusion(GTX)also has been considered asa therapeutic modality for life threateningbacterial and fungal infections in severe neutropenicpatients.Although preclinical and clinical studies suggested that GTX might help to clear infection and increased survival,the results of randomized controlled trials showed that the efficacy and eligible patients were still unclear.With the development of new anti-bacterial and anti-fungal drugs and the use of G-CSF to shorten duration of neutropenia,the clinical use of GTX is confronted with unprecedented challenge.This review will summarize the domestic and international situation of GTX in the past ten years,aswell as the efforts made by researchers to identify the dose,timing,indications,efficacy of GTX andto improve the efficiency of GTX.More importantly,the possible development of GTX will be discussed.

关 键 词：粒细胞输注 粒细胞缺乏 细菌感染 真菌感染 抗菌药物耐药 

分 类 号：R457.1[医药卫生—治疗学] R557.3[医药卫生—临床医学]