造血干细胞移植与结核病

Hematopoietic stem cell transplantation and tuberculosis

造血干细胞移植是将原始的造血干细胞移植入患者体内,实现造血细胞和免疫细胞的重建,其适应证除了血液病以外还包括原发性免疫缺陷病等先天遗传性疾病。原发性免疫缺陷病患者易发生结核病,常感染毒力弱的卡介苗和非结核分枝杆菌,可出现全身播散而威胁生命。重症联合免疫缺陷病、慢性肉芽肿病和孟德尔遗传易感分枝杆菌病是最易发生卡介苗相关并发症的原发性免疫缺陷病,可以通过造血干细胞移植获得治愈。造血干细胞移植前存在活动性结核病的患者,移植前应接受抗结核药物治疗,在原发病情允许的情况下尽可能在移植前控制结核病。造血干细胞移植受者结核病发生风险高,建议所有造血干细胞移植受者移植前行结核分枝杆菌潜伏感染筛查,阳性患者进行预防性抗结核药物治疗。

Hematopoietic stem cell transplantation(HSCT)is to transplant the original hematopoietic cells into the patient’s body to reconstruction the hematopoietic cells and immune cells.In addition to blood diseases,the indications also include congenital genetic diseases such as primary immunodeficiency diseases.Patients with primary immunodeficiency disease are prone to tuberculosis.They are often susceptible to BCG and nontuberculous mycobacterium,which can spread throughout the body and threaten their lives.Severe combined immunodeficiency disease,chronic granulomatosis and Mendelian susceptible mycobacterial disease are the primary immunodeficiency diseases most prone to BCG related complications,which can be cured by HSCT.Patients with active tuberculosis before HSCT should receive anti-tuberculosis drugs,and control tuberculosis before transplantation as much as possible if the primary condition is controllable.Patients with HSCT have a high risk of tuberculosis.It is recommended that all the patients who are waiting for HSCT should be screened for latent tuberculosis infection before transplantation,and the positive patients should be treated with preventive anti-tuberculosis drugs.