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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/OL]. 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/OL]. 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
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