造血干细胞移植术后感染并发症临床分析

发布时间：2018-06-22 21:28

  本文选题：造血干细胞移植 + 感染　； 参考：《苏州大学》2015年硕士论文

【摘要】：目的探讨造血干细胞移植(Hematopoietic stem cells transplantation, HSCT)后不同时期并发感染的临床特征,为经验性防治HSCT后感染并发症提供依据。方法回顾性分析我院(苏州大学附属第一医院)血液科2013年381例HSCT患者移植后感染的发生率、病原菌分布及感染相关因素。结果1、干细胞移植术后0-180天感染累积发生率为84.2%,发生中位时间为移植后+22(0-180)天。0-30天(早期)、30-100天(中期)、100-180天(晚期)感染发生率分别为61.2%、65.6%、26.1%。2、HSCT后0-180天共检测出168株细菌,0-30天检测阳性菌株占50.0%(84/168)。HSCT后0-180天血流感染阳性菌株83株,0-30天检测阳性菌株占80.7%(67/83),其中革兰阴性菌占72.3%(60/83),革兰阳性菌占27.7%(23/83)。血流感染阳性菌株中多药耐药菌(Multiple drug resistant bacterial, MDR)51株(占61.4%),以革兰阴性菌为主(76.5%)。细菌感染中0-30天MDR菌株比例为59.5%,30-100天MDR菌株比例为77.1%,100-180天MDR菌株比例为78.5%。3、HSCT病毒感染主要发生于30-100天,0-180天巨细胞病毒(Cytomegalovirus, CMV)、EB病毒(Epstein-barr virus, EBV)感染累积发生率分别为26.5%、20.5%,其中血清CMV-PP65或CMV-DNA定量阳性118例,EBV-DNA定量阳性82例。4. HSCT后0-30天、30-100天、100-180天侵袭性真菌感染(Invasive fungal infection, IFI)发生率分别为5.2%(20/381)、7.9%(26/331)、3.0%(9/303)。0-180天确诊IFI例数占0.1%(1/1015),临床诊断IFI占3.2%(32/1015),拟诊IFI占2.2%(22/1015)。5、本研究对HSCT患者性别、年龄(≥40岁或40岁)、疾病种类、移植类型、人类白细胞抗原(Human leukocyte antigen, HLA)配型、预处理方案(清髓或非清髓)、抗胸腺细胞球蛋白(Antithymocyte globulin, ATG)/抗淋巴细胞球蛋白(Antilymphocyte globulin, ALG)应用及移植物抗宿主病(Graft-versus-host disease, GVHD)等相关因素进行统计学分析,多因素分析(Lodistic回归)结果示：ATG/ALG应用、Ⅱ-Ⅳ度aGVHD是早期感染发生的独立危险因素；ATG/ALG应用、HLA配型半相合、Ⅱ-Ⅳ度aGVHD是中期感染发生的独立危险因素；cGVHD是晚期感染发生的独立危险因素。结论造血干细胞移植术后感染以细菌感染为主,往往伴有病毒、真菌混合感染,细菌感染主要为革兰阴性杆菌,且多为多药耐药菌；移植后期感染率虽然明显下降,但MDR菌株比例显著上升；移植后病毒感染主要发生在30-100天,真菌感染多贯穿于移植后各时期,以早中期为主；ATG/ALG应用、HLA配型不合、GVHD发生及程度是HSCT术后感染发生的独立危险因素。
[Abstract]:Objective to investigate the clinical features of infection after hematopoietic stem cell transplantation (HSCT) at different stages, and to provide evidence for empirical prevention and treatment of infection complications after hematopoietic stem cell transplantation (HSCT). Methods the incidence of infection, the distribution of pathogenic bacteria and the related factors of infection in 381 HSCT patients in our hospital (the first affiliated Hospital of Suzhou University) in 2013 were analyzed retrospectively. Results 1. The cumulative infection rate of 0-180 days after stem cell transplantation was 84.2. The median time of infection was 22 (0-180) days, 0-30 days (early) 30-100 days (metaphase) and 100-180 days (late stage) of stem cell transplantation. The incidence of infection was 61.2%, 65.60.26.1.2HSCT 0-180 days after transplantation, 168 strains of bacteria were detected. 80.7% (67 / 83) of positive strains were detected 0-30 days after HSCT. 72.3% (60 / 83) of Gram-negative strains and 27.7% (23 / 83) of Gram-positive bacteria. Among the positive strains of blood stream infection, 51 strains (61.4%) were multiple drug resistant bacterial, MDR, and 76.5% (76.5%) were Gram-negative strains. The proportion of MDR strains from 0-30 days to 100 days after bacterial infection was 59.5% and 30-100 days respectively, and the proportion of MDR strains was 77.1% and 100-180 days. The proportion of MDR strains was 78.5%. 3% HSCT virus infection occurred mainly in 30-100 days and 0-180 days of Cytomegalovirus virus (CMV) Epstein-Barr virus (EBV) infection cumulative incidence was 26.5T 20.5T, respectively. CMV-PP65 or CMV-DNA quantitative positive in 118 patients with EBV-DNA quantitative positive in 82 cases. The incidence of invasive fungal infection (IFI) was 5.2% (20 / 381) or 7.9% (26 / 331), 0.1% (1 / 1015), 3.2% (32 / 1015) and 2.2% (22 / 1015), respectively. Human leukocyte antigen-matching, pretreatment regimen (myeloablative or non-myeloablative), antithymocyte globulin (Antithymocyte globulin,) / antilymphocyte globulin (Antilymphocyte globulin,) and graft-versus-host disease (GVHD) were analyzed statistically. The results of multivariate analysis (Lodistic regression) showed that grade 鈪，

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