非血缘脐血造血干细胞移植术后早期并发感染的临床特点

Clinical Characteristics of Patients With Infectious Complications Following Umbilical Cord Blood Transplantation

目的探讨非血缘脐血移植（UCBT）术后早期感染的临床特点和防治策略。方法选择2010年7月至2012年9月于本院行UCBT术后发生早期感染的恶性血液病患者107例为研究对象。回顾性分析患者早期感染的发生率及病原菌的分布情况。结果107例患者UCBT术后，96例获得造血重建，11例移植失败。本组患者100d内死亡18例，其中与感染相关死亡共9例。100d内59例（56％）患者共发生感染85次，且均有不同程度的发热。其中，下呼吸道是最常见的感染部位，占37．7％。自31例患者共分离出病原菌36株，其中革兰阴性（G-）菌占61．1％。70例患者（65．4％）移植后巨细胞病毒（CMV）-DNA呈阳性。结论UCBT后100d内的感染多发生于粒细胞缺乏期。呼吸道是本组患者常见感染部位，下呼吸道感染患者的病死率最高，病原菌以G一杆菌为主。

Objective To investigate the clinical etiological characteristics and risk factors of infections after umbilical cord blood transplantation （UCBT）. Methods From July 2010 to September 2012, a total of 107 patients with hematologic malignancies who occurred infection in the early stage after UCBT were included in this study. The clinical etiological characteristics and risk factors of all these patients were retrospectively analyzed. Result Among 107 cases, engraftment was achieved in 96 cases, 11 cases suffered from graft rejection and 9 cases died of infectious complications. 85 infectious episodes were recorded from 59 patients （56%） within 100 days after UCBT. All infectious cases experienced febrile episodes. The common infectious sites were respiratory tract （37.7%）. 36 isolates of bacteria were detected in 31 patients. 61.1% of isolates were gram-negative bacillus. 70 patients （65.4%） got cytomegalovirus （CMV） infection. Conclusions The infectious complications within 100 days after UCBT mostly occurred before engraftment. Mucositis of respiratory infection were common. Fungal infection was the main causes of infectious mortality. Gram-negative microorganisms were the main pathogens.