异基因造血干细胞移植后结核分枝杆菌感染8例临床分析

A Clinical Analysis of 8 Cases of Tuberculous Infections Following Allogeneic Hematopoietic Stem Cell Transplantation

目的探讨异基因造血干细胞移植后合并结核分枝杆菌感染的临床特点、实验室诊断、治疗和预后。方法收集接受造血干细胞移植(HSCT)后发生结核分枝杆菌感染的8例患者资料,包括2例急性淋巴细胞白血病,5例急性髓系白血病,1例重型再生障碍性贫血;其中男6例,女2例;年龄17~57岁,中位年龄41岁。回顾性分析总结8例患者的临床特点、实验室检测、治疗和预后。结果8例患者结核菌感染类型分别为4例淋巴结结核、3例肺结核以及1例结核性胸膜炎。8例干扰素释放试验均为阳性,有2例结核PCR阳性,1例病理组织抗酸染色阳性;8例患者经临床症状、实验室检查阳性、诊断性抗结核治疗有效而确诊;正规4联或3联常规抗结核治疗后,3例患者合并细菌真菌严重感染后病危放弃治疗,2例患者治愈后未反复,1例患者治疗有效出院继续口服抗结核药物,2例淋巴结结核治疗近两年结核感染反复,未能治愈至今仍在治疗中。结论异基因造血干细胞移植后结核分枝杆菌感染的诊断是难点,应该重视对高危人群进行移植前结核筛查及移植后的结核预防。实验室干扰素释放试验联合其他检测及影像学检查对早期诊断有一定意义,部分患者接受正规治疗仍可以取得较好的抗结核疗效。

Objective To explore the clinical characteristics,laboratory test results,treatment outcomes and prognosis of tuberculosis infections(TB)following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A retrospective study was performed on 8 allo-HSCT recipients diagnosed with TB(including 2 cases of acute lymphoblastic leukemia,5 cases of acute myeloid leukemia and 1 case of severe aplastic anaemia;6 were male and 2 were female;the median age was 41 years old ranging from 17 years to 57 years)at our hospital from January,2013 to June,2015.The diagnosis,clinical features,laboratory test results,treatment outcomes and prognosis were evaluated.Results The types of the TB were various.of 8 allo-HSCT recipients,4 patients were diagnosed as lymphadenitis TB,while 4 patients were diagnosed as pulmonary TB and 1 patient was diagnosed as pleurisy TB.All cases were positive for TB-IGRA,2 cases had TB PCR positive and 1 case had acid-fast positive.8 cases were diagnosed with criterial including:special clinical symptom positive,laboratory examinations and clinical response to antituberculosis drugs.Anti-tuberculosis was applied to 8 cases,among those 3 patients with bacterial and fungal infection stopped treatments,2 patients showed tuberculosis cured without relapse,1 cases of patients were discharged to continue oral anti tuberculosis drugs,and 2 lymphadenitis TB patients failed to cure were still in the treatment.Conclusion Early clinical diagnosis of tuberculosis infections(TB)following allogeneic hematopoietic stem cell transplantation remains a challenge.Tuberculosis screening in high-risk groups and prevention of tuberculosis after transplantation in high-risk population should be paid attention to.TB-IGRA test combined with other detection and imaging examination for the early diagnosis has a certain significance.Some patients under regular treatment can still achieve good anti tuberculosis effect.