切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (03) : 245 -250. doi: 10.3877/cma.j.issn.1674-1358.2017.03.008

临床论著

再生障碍性贫血异基因造血干细胞移植后并发早期感染的临床研究
毕磊1, 郭智2,()   
  1. 1. 100700 北京,解放军陆军总医院干一科
    2. 518000 深圳市,中国医学科学院肿瘤医院深圳医院血液淋巴瘤科
  • 收稿日期:2016-11-27 出版日期:2017-06-15
  • 通信作者: 郭智
  • 基金资助:
    北京市首都临床特色课题(No. Z151100004015218)

Clinical study of aplastic anemia with early infection complications following allogeneic hematopoietic stem cell transplantation

Lei Bi1, Zhi Guo2,()   

  1. 1. Department of First Cadre Ward, PLA Army General Hospital, Beijing 100700, China
    2. Department of Blood Lymphoma, Shenzhen Hospital of Chinese Academy of Medical Sciences Tumor Hospital, Shenzhen 518000, China
  • Received:2016-11-27 Published:2017-06-15
  • Corresponding author: Zhi Guo
引用本文:

毕磊, 郭智. 再生障碍性贫血异基因造血干细胞移植后并发早期感染的临床研究[J]. 中华实验和临床感染病杂志(电子版), 2017, 11(03): 245-250.

Lei Bi, Zhi Guo. Clinical study of aplastic anemia with early infection complications following allogeneic hematopoietic stem cell transplantation[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(03): 245-250.

目的

探讨再生障碍性贫血异基因造血干细胞移植后并发早期感染的临床特点。

方法

回顾性分析解放军某医院血液科2009年1月至2015年12月因再生障碍性贫血接受异基因造血干细胞移植后的65例患者资料,预处理方案包括环磷酰胺、氟达拉滨和人淋巴细胞免疫球蛋白,采用骨髓联合外周血干细胞移植,移植物抗宿主病预防采用联合免疫抑制剂包括环孢素A、氨甲蝶呤和他克莫司等,观察全部患者毒副反应、早期并发症和无病生存率等。

结果

随访至2016年2月,其中60例患者获造血重建,5例患者移植失败;移植3个月内共48例患者发生85次感染,按部位分为口腔15例次、上呼吸道18例次、肺部25例次、腹腔6例次、泌尿系8例次、血液11例次、皮肤及软组织2例次;按病原学分为70例细菌、7例真菌、8例巨细胞病毒,因感染死亡10例,发生急性移植物抗宿主病9例,死亡4例,患者总生存率为52.1%。

结论

再生障碍性贫血患者异基因造血干细胞移植后3个月内感染发生率高,其中肺部感染及真菌感染预后相对较差。

Objective

To investigate the clinical features of early infection with allogeneic hematopoietic stem cell transplantation for the treatment of aplastic anemia.

Methods

The clinical data of 65 patients with aplastic anemia in the department of People’s Liberation Army Hospital from January 2009 to December 2015 were analyzed, retrospectively. The conditioning regimen contained cyclophosphamide, fludarabine and antithymocyte globulin. Ciclosporin A, methotrexate, tacrolimus and so on were used for preventing graft versus host disease. Transplantation method was bone marrow mobilization combined with peripheral blood stem cell transplantation. The adverse reaction, early complications and disease free survival in all patients were analyzed, respectively.

Results

Following up to February 2016, 60 patients received hematopoietic reconstitution and 5 patients got failed transplantation. Total of 48 patients experienced 85 times infections within three months after transplantation, according to the location of infections, there were 15 case-times with oral cavity infection, 18 case-times with upper respiratory tract infection, 25 case-times with lung infection, 6 case-times with abdominal cavity infection, 8 case-times with urinary infection, 11 case-times with blood infection, 2 case-times with skin and soft tissue infection. According to etiology, 70 cases were with bacteria infection, 7 cases were with fungi infection, 8 cases were with cytomegalovirus infection, and 10 cases of death were due to infection. There were 9 cases with acute graft versus host disease, 4 cases died, with overall survival rate as 52.1%.

Conclusions

The rates of infectious complications for patients of aplastic anemia after allogeneic hematopoietic stem cell transplantation were high within three months, among which lung infection and fungal infection were with poor prognosis.

表1 48例感染者早期感染情况[例(%)]
表2 48例感染者早期病原菌感染分类
[1]
Peinemann F, Bartel C, Grouven U. First-line allogeneic hematopoietic stem cell transplantation of HLA-matched sibling donors compared with first-line ciclosporin and/or antithymocyte or antilymphocyte globulin for acquired severe aplastic anemia[J]. Cochrane Database Syst Rev,2013,23(7):CD006407.
[2]
郭智, 刘晓东, 杨凯, 等. allo-HSCT并使用高剂量环磷酰胺诱导免疫耐受治疗重型再生障碍性贫血[J]. 中华器官移植杂志,2015,36(6):356-361.
[3]
郭智, 陈惠仁, 刘晓东, 等. 单倍型异基因造血干细胞移植治疗儿童重型再生障碍性贫血[J]. 中华实用儿科临床杂志,2014,29(15):1145-1148.
[4]
Kobayashi R, Yabe H, Kikuchi A, et al. Bloodstream infection after stem cell transplantation in children with idiopathic aplastic anemia[J]. Biol Blood Marrow Transplant,2014,20(8):1145-1149.
[5]
Demiraslan H, Sevim M, Pala Ç, et al. Risk factors influencing mortality related to Stenotrophomonas maltophilia infection in hematology-oncology patients[J]. Int J Hematol,2013,97(3):414-420.
[6]
Guinan EC. Diagnosis and management of aplastic anemia[J]. Hematology Am Soc Hematol Educ Program,2011,2011(1):76-81.
[7]
中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订版)[J]. 中华内科杂志,2013,52(8):704-709.
[8]
中华医学会血液学分会, 中国医师协会血液科医师分会. 中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南[J]. 中华血液学杂志,2012,33(8):693-696.
[9]
郭智, 陈惠仁, 杨凯, 等. 免疫耐受新方法单倍型造血干细胞移植治疗重型再生障碍性贫血[J]. 中国组织工程研究,2015,19(41):6683-6687.
[10]
Lee YH, Kim JY, Choi BO, et al. Total lymphoid irradiation based conditioning for hematopoietic stem cell transplantation in severe aplastic anemia[J]. Radiat Oncol J,2012,30(4):165-172.
[11]
Jaiswal SR, Chatterjee S, Mukherjee S, et al. Pre-transplant sirolimus might improve the outcome of haploidentical peripheral blood stem cell transplantation with post-transplant cyclophosphamide for patients with severe aplastic anemia[J]. Bone Marrow Transplant,2015,50(6):873-875.
[12]
童春, 郭智, 楼金星, 等. 单倍型异基因造血干细胞移植治疗重型再生障碍性贫血:回顾性分析[J]. 中国组织工程研究,2015,19(36):5821-5826.
[13]
Pillai A, Hartford C, Wang C, et al. Favorable preliminary results using TLI/ATG-based immunomodulatory conditioning for matched unrelated donor allogeneic hematopoietic stem cell transplantation in pediatric severe aplastic anemia[J]. Pediatr Transplant,2011,15(6):628-634.
[14]
Bashey A, Zhang X, Sizemore CA, et al. T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation[J]. J Clin Oncol,2013,31(10):1310-1316.
[15]
Esteves I, Bonfim C, Pasquini R, et al. Haploidentical BMT and post-transplant Cy for severe aplastic anemia: a multicenter retrospective study[J]. Bone Marrow Transplant,2015,50(5):685-689.
[16]
朱枫, 陈惠仁, 郭智, 等. 第二次异基因造血干细胞移植治疗植入失败的再生障碍性贫血的临床研究[J]. 中国实验血液学杂志,2014,22(5):1348-1353.
[17]
Ciceri F, Lupo-Stanghellini MT, Korthof ET. Haploidentical transplantation in patients with acquired aplastic anemia[J]. Bone Marrow Transplant,2013,48(2):183-185.
[18]
郭智, 陈惠仁, 刘晓东, 等. 异基因移植后发生泛耐药鲍曼不动杆菌感染的临床分析[J]. 中华全科医学,2014,12(5):673-675.
[19]
Pilcante J, Rojas P, Ernst D, et al. Clostridium difficile infection in Chilean patients submitted to hematopoietic stem cell transplantation[J]. Rev Bras Hematol Hemoter,2015,37(6):388-394.
[20]
郝新建, 周健, 房佰俊, 等. 异基因造血干细胞移植后带状疱疹的临床分析[J/CD]. 中华实验和临床感染病杂志(电子版),2012,6(3):221-224.
[21]
郭智, 陈惠仁, 杨凯, 等. 单倍型异基因造血干细胞移植后患者肺部真菌感染的临床研究[J]. 中华医院感染学杂志,2015,25(13):2999-3001.
[22]
Clay J, Kulasekararaj AG, Potter V, et al. Nonmyeloablative peripheral blood haploidentical stem cell transplantation for refractory severe aplastic anemia[J]. Biol Blood Marrow Transplant,2014,20(11):1711-1716.
[23]
郭智, 陈惠仁, 刘晓东, 等. 异基因造血干细胞移植后发生巨细胞病毒感染的临床分析[J]. 中国实验血液学杂志,2012,20(4):971-974.
[24]
郭智, 何学鹏, 刘晓东, 等. 异基因造血干细胞移植后发生真菌性败血症的临床分析[J]. 中华医院感染学杂志,2012,22(4):709-711.
[25]
郭智, 何学鹏, 刘晓东, 等. 伏立康唑对造血干细胞移植所致真菌感染二级预防的作用[J/CD]. 中华实验和临床感染病杂志(电子版),2011,5(2):36-39.
[1] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[2] 涂家金, 廖武强, 刘金晶, 涂志鹏, 毛远桂. 严重烧伤患者鲍曼不动杆菌血流感染的危险因素及预后分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 491-497.
[3] 廖锵云, 王震, 林洁玉, 廖夏, 邓锦华, 李杰峰, 邓建维, 李明, 荣新洲. 虎门地区创伤弧菌感染的临床观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 394-398.
[4] 蔡柔妹, 曾洁梅, 黄伟丽, 谢文敏, 刘燕丹, 吴漫君, 蔡楚燕. 利用QC小组干预降低经烧伤创面股静脉置管导管相关性感染发生率的临床观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 399-404.
[5] 杨瑞洲, 李国栋, 吴向阳. 腹股沟疝术后感染的治疗方法探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 715-719.
[6] 徐金林, 陈征. 抗菌药物临床应用监测对腹股沟疝修补术预防用药及感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 720-723.
[7] 李静如, 王江玲, 吴向阳. 简易负压引流在腹股沟疝术后浅部感染中的疗效分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 745-749.
[8] 李秉林, 吕少诚, 潘飞, 姜涛, 樊华, 寇建涛, 贺强, 郎韧. 供肝灌注液病原菌与肝移植术后早期感染的相关性分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 656-660.
[9] 赵立力, 王魁向, 张小冲, 李志远. 血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 351-355.
[10] 卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[11] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[12] 卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.
[13] 李静静, 翟蕾, 赵海平, 郑波. 多囊肾合并囊肿的多重耐药菌感染一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 920-923.
[14] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[15] 杨艳丽, 陈昱, 赵若辰, 杜伟, 马海娟, 许珂, 张莉芸. 系统性红斑狼疮合并血流感染的危险因素及细菌学分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 694-699.
阅读次数
全文


摘要