白血病患者异基因外周血造血干细胞移植感染的预防

Prevention and countermeasures to leukemia patients with allogeneic peripheral blood stem cell transplantation infection

目的分析异基因外周血造血干细胞移植对白细胞相关感染的预防对策,以降低感染率。方法回顾性分析2008年2月-2012年8月接受异基因外周血造血干细胞移植的102例白血病患者临床资料,并统计其发生感染的相关危险因素及预防对策。结果 102例白血病患者在移植后发生感染38例,感染率37.25%,血液标本培养出病原体79株,其中细菌43株占54.43%,真菌19株占24.05%,病毒17株占21.52%;通过logistic分析,影响患者移植后感染的相关因素有年龄≥45岁、移植前感染、移植前未缓解、无关供者、未预防性使用抗菌药物、发生≥Ⅲ°急性移植物抗宿主病,其中移植前感染和未预防性使用抗菌药物影响因素最明显,差异有统计学意义(P<0.01)。结论移植前感染和未预防性使用抗菌药物是影响异基因造血干细胞移植治疗白血病相关感染的独立因素,临床要保持病房的无菌,改善环境,进行必要的心理疏导和术后监测的频次等以预防感染的发生。

OBJECTIVE To analyze the prevention and countermeasures of allogeneic peripheral blood stem cell transplantation to leukocyte-associated infections ,so as to reduce the infection rate .METHODS Clinical data of 102 cases leukemia patients who accepted allogeneic peripheral blood stem cell transplantation during Feb .2008 to Aug .2012 were retrospective analyzed and the related risk factors and preventive measures about their infection were counted .RESULTS After transplantation ,38 cases occurred leukemia-associated infection ,among 102 cases , the infection rate reached 37 .25% .Blood preparations cultured pathogen 79 strains ,in w hich bacteria 43 strains , accounting for 54 .43% ,fungi 19 strains ,accounting for 24 .05% and virus 17 strains ,accounting for 21 ,52% . Analyses by logistic ,the related factors that could affect the infections of patients after transplant were as followed：age≥45 ,pre-transplant infection ,non-remission before transplant ,using antibacterial agents without prevention ,the occurrence of acute graft-versus-host-disease ≥ Ⅲ .Among those factors ,pre-transplant infection and using antibacterial agents without prevention were the most obvious factors , and the differences had significance （ P 〈 0 .01 ） . CONCLUSION The pre-transplant infection and using antibacterial agents without prevention are the independent factors that can affect allogeneic hematopoietic stem cell transplantation in the treatment of leukemia-associated infections .It is necessary to maintain sterile ward ,improve the environment , make the necessary psychological counseling and monitor postoperative frequency in order to prevent the occurrence of infections .