造血干细胞移植后真菌感染的防治

Prevention and treatment of fungous infection complications of hematopoietic stem cell transplantation

目的回顾性分析我院造血干细胞移植患者感染并发症的发生及防治情况。方法分析我院1990年9月至2000年3月收治的150例次各种类型造血干细胞移植病例感染并发症的发生及防治情况，根据移植类型、感染发生与否、预防用药、病原学及感染部位等分组并进行统计学分析。结果150例次病例感染的发生率为89．3％（134／150），3例患者死于感染，感染病死率为2％（3／150），这3例均为真菌感染。80例预防或治疗中用过泰能或头孢他啶的病例，真菌感染发生率为32．5％（26／80），而未用过泰能或头孢他啶的病例真茼感染的发生率仅为15．7％（11／70），差异有统计学意义（x^2=12．0471，P〈0．05）。12例真菌感染病例采用小剂量两性霉素B（10mg／d）治疗，治愈率为100％。结论预防性应用广谱强力的抗生素并不能减少感染发生率，反而可能增加真菌感染的机会；小剂量两性霉素B是治疗真菌感染新的、有效而安全的方法。

Objective To retrospectively evaluate the incidence and treatment of fungous infection complications after hematopoietic stem cell transplantation. Methods The incidence, pathogenic microorganism, prophylaxis,treatments of infectious complications in 150 patients, who accepted hematopoietic stem cell transplantation from September 1990 to Martch 2000 in our hospital were analyzed. Results The incidence of infectious complications was 89.3% （134/150） in all 150 cases. Three patients （2%） died of the fungal infection. The incidence of the fungal infections was 32.5% （26/80） in patients who accepted treatment with impenem or/and ceftazidine, and 15.7% （11/70） in other patients without the above treatment （P 〈0.05）. 12 fungal infection cases were treated with small-dosage of amphotericin B（ 10 mg/d） ,with the healing rate was 100%. Conclusion The strong antibacterial prophylaxis can＇t reduce the incidence of infection,but may increase the risk of fungal infection;small-dosage of amphotericin B is a new effective way to treat fungal infection.