造血干细胞移植患者早期发生呼吸道感染的危险因素分析

Risk factors of respiratory infections in patients with hematopoietic stem cell transplantation at early stage

目的:研究骨髓造血干细胞(HSC)移植患者早期呼吸道感染的发病情况及其与造血功能重建的关系,分析HSC移植早期呼吸道感染的危险因素。方法:回顾性病例对照研究HSC移植患者168例的临床资料,进行单因素和多因素Logistic回归分析。结果:HSC移植早期呼吸道感染率为72.6%,上呼吸道感染率为44.0%,下呼吸道感染率为28.6%。81.1%的患者呼吸道感染发生于造血功能重建前。单因素分析显示,移植早期呼吸道感染的危险因素是年龄、干细胞来源、预处理方式、非亲缘移植、人类白细胞抗原(HLA)不匹配移植和血象恢复时间,独立危险因素有年龄和非亲缘移植。上呼吸道感染单因素分析的危险因素为年龄、干细胞来源、非亲缘移植、HLA不匹配移植和血象恢复时间,独立危险因素是年龄和非亲缘移植;而下呼吸道感染的单因素分析的危险因素为干细胞来源、非亲缘移植、HLA不匹配移植和真菌性肺炎病史和发生移植物抗宿主病(GVHD),独立危险因素为HLA不匹配移植和真菌性肺炎病史。结论:HSC移植早期呼吸道感染率较高,独立危险因素有年龄、非亲缘移植、HLA不匹配移植和真菌性肺炎病史。

To investigate the pathological status, hematopoietic reconstitution and risk factors of respir- atory infections （RI） in the patients with hematopoietic stem cell （HSC） transplantation at early stage. METHODS： The retrospective and case -control study, single -factor and Logistic analysis were performed to analyze the clinical data of 168 patients with HSC transplantation. RESULTS： The incidence rate of RI was 72.6%, upper RI was 44.0%, and low- er RI was 28.6%. The cases with RI attacked before hematopoietic reconstitution were 81.1%. The risk factors of RI ana- lyzed by single factor were age, origin of HSC, pretreatment, non - genetic transplantation, non - complete matching of hu- man leukocyte antigen （HLA）, hemogram recovery time, and independent risk factors were age and non - genetic trans- plantation. The risk factors of upper RI were age, origin of HSC, non - genetic transplantation, non - complete matching of HLA, hemogram recovery time, and independent risk factors were age and non - genetic transplantation. The risk factors of lower RI were the origin of HSC, non - genetic transplantation, non - complete matching of HLA, history of fungal pneu- monia and graft - versus - host disease （ GVHD）, and independent risk factors were non - complete matching of HLA and history of fungal pneumonia. CONCLUSION： Higher incidence rate of RI exists at early stage of HSC transplantation, and independent risk factors include age, non - genetic transplantation, non - complete matching of HLA and history of fungal nneumonia.