异基因造血干细胞移植后肺部感染研究

Study on pulmonary infection following allogeneic hematopoietic stem cell transplantation

目的：探讨异基因造血干细胞移植术后肺部感染的临床特征及危险因素。方法回顾分析2010～2012年收入该院的37例异基因造血干细胞移植患者的临床资料。结果17例患者异基因造血干细胞移植后发生33例次肺部感染，其中11例患者发生2次及以上的肺部感染，总发生率45．9％，直接死于肺部感染的有5例。仅39．4％（13/33）肺部感染有病原学证据，真菌感染尤其是白假丝酵母菌较为多见。单因素分析显示：肺部感染与供受者人类白细胞抗原（HLA）不全相合、移植物抗宿主病（GVHD）显著相关（P＝0．041、0．013），与其他因素无相关性（P＞0．05）。多因素分析显示：供受者HLA不全相合及GVHD与肺部感染显著相关（P＝0．041、0．021）。结论异基因造血干细胞移植术后肺部感染是常见并发症，对患者威胁较大。HLA不全相合及GVHD与移植后肺部感染显著相关。

Objective To investigate the clinical characteristics and risk factors of pulmonary infection after allogeneic hemato-poietic stem cell transplantation（allo-HSCT） .Methods The clinical data of 37 allo-HSCT patients treated in our transplantation u-nit from 2010 to 2012 were performed the retrospective analysis .Results Among 17 cases of allo-HSCT ,33 case-times of pulmona-ry infection occurred after transplantation ,in which more than twice pulmonary infection occurred in 11 cases ,the total occurrence rate of pulmonary infection was 45 .9% （17/37） .5 cases directly died of pulmonary infection .Only 39 .4% case-times of pulmonary infection had the pathogenic evidence .Fungal infection ,especially Candida albicans ,was predominant .The univariate analysis showed that pulmonary infection was significantly associated with human leucocyte antigen （HLA） non-identical of donor and recip-ient and graft versus host disease（GVHD）（P=0 .041 ,0 .013） ,and had no obvious correlation with the other factors （P＆gt;0 .05） . The multivariate analysis showed that the HLA non-identical of donor and recipient and GVHD were significantly associated with the occurrence of pulmonary infection （P=0 .041 ,0 .021） .Conclusion Postoperative pulmonary infection is a common complication following allo-HSCT ,which has larger threat to the patients .HLA non-identical and GVHD are significantly correlated with pulmo-nary infection after allo-HSCT .