造血干细胞移植后侵袭性真菌病的临床研究

Clinical studies of invasive fungal infections following hematopoietic stem cell transplantation

目的探讨造血干细胞移植（hematopoietic stem cell transplantation，HSCT）后侵袭性真菌病（invasive fugal disease，IFD）的发生率、发病时间、临床表现及治疗效果。方法对军事医学科学院附属医院造血干细胞移植科2000年1月至2006年12月326例行HSCT的病例进行回顾性分析。结果326例行HSCT的患者中39例发生了IFD，发生率为11.9％。确诊9例，临床诊断21例，拟诊9例。39例IFD中，念珠菌病7例，霉菌病32例。HLA相合同胞、无关相合或相关不合及自体HSCT的IFD发生率分别为11.1％（26／234），18.5％（10／54）和7.9％（3／38）。30例出现IFD患者有移植物抗宿主病（graft versus host disease，GVHD）。IFD发生的中位时间78（17～198）d，临床表现主要是发热，广谱抗生素治疗无效，部分患者出现低氧血症。39例中，存活2l例，死亡18例，联合抗真菌药物治疗9例患者6例存活。结论IFD是HSCT后的主要死亡原因，无关供者和相关不合的HSCT的IFD发生率明显升高，有GVHD患者发生IFD机会明显增加，联合抗真菌治疗效果有待进一步证实。

Objective To explore the incidence,time of onset,clinical presentation and outcome of patients with IFD following HSCTf. Methods Analyse the data of 326 patients underwent HSCT from January 2000 to December 2006 in our hospital. Results IFD occurred in 39 patients,incidence of IFD being 11.9%. Proven, probable and possible diagnoses were 9,21 and 9 cases respectively. Of these, Candida and Mold were 7 and 32;IFD in HLA matched identical,unrelated matched or related mismatched and autologous HSCT were 26,10 and 3 cases, incidence of whom were 11.1% （26/234）, 18. 5% （ 10/54 ） and 7.9% （ 3/38 ） respectively. Thirty IFD patients were concomitant with GVHD. Mean time on IFD was 78 （ 17 ～ 198 ）days. Clinical presentations were fever;they had no response to broad-spectrum antibiotic and there was hy poxemia in some patients. Twenty-one survive and 18 died. Six patients survived with combination treatment in 9 patients. Condusion IFD is leading cause of mortality following HSCT. IFD increases significantly in Unrelated matched and related mismatched HSCT. IFD is high in patients with GVHD. Combination treatment needs further research.