异基因造血干细胞移植后侵袭性真菌病危险因素分析

Risk factors of invasive fungal disease after allogeneic hematopoietic stem cell transplantation

目的了解血液系统恶性疾病患者异基因造血干细胞移植(allo-HSCT)术后侵袭性真菌病(IFD)的发病率、危险因素。方法选择2007年1月至2013年11月于重庆医科大学附属第一医院HSCT中心接受allo-HSCT的患者82例,按照我国IFD诊断标准进行回顾性分析。结果 82例allo-HSCT术后患者,共诊断22例IFD,发生率为26.83%,其中确诊IFD者5例(22.73%),临床诊断者7例(31.82%),拟诊者10例(45.45%)。3、6、12个月的累积发病率分别为11.10%、15.30%、22.60%。多因素分析中,移植前真菌感染史、HLA配型不合是IFD早期的危险因素;广谱抗菌药物使用、大剂量激素使用为IFD晚期的危险因素。结论 IFD是allo-HSCT术后严重并发症,其发生率和病死率均较高。HLA配型不合、移植前真菌感染史、持续中性粒细胞缺乏、大剂量激素使用、广谱抗菌药物使用、慢性移植物抗宿主病(GVHD)是IFD的危险因素。

Objective To examine the risk factors and incidence of invasive fungal disease（IFD）in recipients after allogeneic hematopeietic stem cell transplantation（allo-HSCT）. Methods We performed a study of eighty-two patients undergoing allo-HSCT from January 2007 to November 2013. We defined IFD using standard criteria and selected proven, probable and possible cases for retrospective review. Results For 82 cases,22 cases of IFD（26.83%）were identified,including 5 proven IFD（22.73%） ,7 Probable IFD（31.82 % ）and 10 possible IFD（45.45 %）cases respectively. The cumulative incidence rate of IFD for 3 months, 6 months and 12 months was 1 1.10 % 15.30 %, 22.60 % respectively. Univariate analysis showed that neutrophil d0. 5 ×109/L more than 14 days, previous history of IFD as risk factors of early IFD after allo-HSCT, and previous history of IFD, glueocorticosteroid use, antibiotics use, chronic GVHD as risk factors of late IFD. In multivariate analysis, the early risk factors were HLA unmatched, previous history of IFD, while glucocorticosteroid use,antibiotics use were risk factors of late IFD. Conclusion IFD was one of the severe complica- tions after allo-HSCT with high incidence and mortality. Its risk factors were HLA unmatched, previous history of IFD, neutrophil〈0. 5 × 109/L more than 14 days,glucoeorticosteroid use,antibiotics use,chronic GVHD.