儿童急性白血病半相合造血干细胞移植后侵袭性真菌病的危险因素  

The risk factors of invasive fungal disease after haploid hematopoietic stem cell transplantation in children with acute leukemia

作　　者：程镕琪 胡冠华[1] 柏露[1] 锁盼[1] 王昱[1] 张晓辉[1] 刘开彦[1] 许兰平[1] 黄晓军[1] 程翼飞[1] Cheng Rongqi;Hu Guanhua;Bai Lu;Suo Pan;Wang Yu;Zhang Xiaohui;Liu Kaiyan;Xu Lanping;Huang Xiaojun;Cheng Yifei(Peking University People's Hosptital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing 100044,China)

机构地区：[1]北京大学人民医院血液科、北京大学血液病研究所、国家血液系统疾病临床医学研究中心、造血干细胞移植治疗血液病北京市重点实验室,北京100044

出　　处：《中国综合临床》2023年第5期363-367,共5页Clinical Medicine of China

摘　　要：目的探讨儿童急性白血病半相合造血干细胞移植(haploid hematopoietic stem cell transplantation,haplo-HSCT)后侵袭性真菌病(invasive fungal disease,IFD)的危险因素。方法回顾性分析北京大学人民医院2016年1月至2020年12月接受haplo-HSCT治疗402例急性白血病患儿的临床资料。收集患儿一般情况和移植术前指标,包括性别、年龄、原发病、原发病缓解状态、既往IFD病史;收集患儿移植术后指标,包括长期粒细胞缺乏时间、大剂量糖皮质激素的应用、CD25单抗的应用、急性及慢性移植物抗宿主病。计数资料以例(%)表示,组间比较采用连续校正的χ^(2)检验或Fisher确切概率法。应用Logistic回归模型对儿童急性白血病haplo-HSCT后IFD的危险因素进行多因素分析。结果402例患儿中男250例,女152例;进行移植时中位年龄10岁,年龄范围为9个月至17岁7个月;移植前390例患儿原发病达到完全缓解,9例部分缓解,3例未缓解;中性粒细胞植入时间范围为10~24 d,中位时间12 d。术后发生IFD 17例(4.2%),其中确诊3例(0.7%),临床诊断14例(3.5%);IFD的发生时间为移植后13~275 d,中位时间30 d。肺部是最常见的感染部位(88.2%,15/17)。多因素Logistic回归分析结果表明,年龄>10岁(比值比=3.05,95%置信区间:1.02~9.13,P=0.046)、大剂量糖皮质激素的应用(比值比=7.72,95%置信区间:1.85~32.20,P=0.005)为儿童haplo-HSCT后IFD的危险因素。结论IFD是儿童急性白血病haplo-HSCT后的重要并发症,年龄>10岁、大剂量糖皮质激素的应用为儿童haplo-HSCT后IFD的危险因素。Objective To investigate the risk factors of invasive fungal disease after haploid hematopoietic stem cell transplantation in children with acute leukemia.Methods Four hundred and two children(median age 10 years)with acute leukemia,undergoing haplo-HSCT at this institutute from January 2016 to December 2020,were analyzed retrospectively according to the diagnosis criteria of IFD.The basic information and preoperative indicators of the children were collected,including gender,age,primary disease,remission status of primary disease,and previous IFD history.Postoperative indicators were collected,including long-term granulocyte deficiency time,high-dose glucocorticoids,using CD25 monoclonal antibody,acute and chronic graft-versus-host disease.Count data are expressed as example(%),and comparisons between groups are made using the continuously multifactorial corrected Chi-square test or Fisher exact probability method.Logistic regression model was used to analyze the risk factors of IFD after haplo-HSCT in children.Results Among 402 cases,250 were male and 152 were female.The median age at transplantation was 10 years,and the age range was 9 months to 17 years 7 months.Before transplantation,390 cases achieved complete remission of the primary disease,9 cases had partial remission,and 3 cases had no remission.The implantation time of neutrophils ranged from+10 to 24 days,with a median time of 12 days.IFD occurred in 17 cases(4.2%),of which 3 cases(0.7%)were proven IFD and 14 cases(3.5%)were probable IFD.IFD occurred from 13 to 275 days after transplantation,with a median time of 30 days.The lungs were the most common site of infection(88.2%,15/17).The multivariate Logistic regression analysis showed that age>10 years old(P=0.046,odds ratio=3.05,95%confidence interval:1.02~9.13),the use of high-dose corticosteroids(P=0.005,odds ratio=7.72,95%confidence interval:1.85~32.20)were risk factors for IFD after haplo-HSCT in children.Conclusions IFD is an important complication after haplo-HSCT in children with acute leukemi

关 键 词：侵袭性真菌病 半相合造血干细胞移植 急性白血病 

分 类 号：R733.71[医药卫生—肿瘤] R457.7[医药卫生—临床医学]