异基因造血干细胞移植并发肺部侵袭性真菌感染及其影响因素研究

Affecting factors analysis of pulmonary invasive fungal infection in patients after allogeneic haemopoietic stem cell transplantation

目的探讨异基因造血干细胞移植(allo-HSCT)后肺部侵袭性真菌感染的影响因素,以便早期诊治,提高疗效。方法观察85例allo-HSCT患者发生肺部侵袭性真菌感染的临床特点、早期诊治和临床疗效的关系。结果85例allo-HSCT后10例发生肺部侵袭性真菌感染,临床诊断7例,确诊1例,拟诊2例。经过早期抗真菌治疗,4例完全恢复,1例稳定,2例放弃治疗,3例死亡。结论allo-HSCT后免疫功能尚未完全恢复或使用免疫抑制剂的患者,若出现发热应高度警惕真菌感染的可能。对有高危宿主因素、结合临床表现、真菌检查结果及早期肺部CT影像学证据,尽早使用抗真菌治疗是提高疗效的重要环节。

Objective To explore the affecting factors of pulmonary invasive fungal infection in patients after allogeneic haemopoietic stem cell transplantation for early diagnosis and therapy. Methods To observe the clinical characteristic and correlation between early therapy and clinical efficacy in 85 patients with pulmonary invasive fnngal infection after allogeneic haemopoietic stem cell transplantation. Results In 85 patients, 10 suffered from pulmonary invasive fungal infection. Among them,7 were of clinical diagnosis, 1 was comfirmed,snd,2 possible. After early antifungal treatment, 4 patients recovered completely, 1 was stable, 2 cases gave up and 3 cases was dead. Conclusions We should be precautious of fungal infection among febrile patients after allo-HSCT whose immune reconstitution has not recovered or been treated with immunosuppressor. Ealy antifungal therapy is a important tacbe to improve curative effect for those with high-risk host factos, clinical manifestation,positive mycological results and early pulmonary CT scans.