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目的了解造血干细胞移植(HSCT)后患者侵袭性真菌感染(IFI)的发病率及危险因素。方法选择2003年6月至2004年9月于我所进行 HSCT 的患者148例,按照我国 IFI 的诊断标准及临床疗效进行回顾性分析。结果诊断 IFI 的患者共52例,其中确诊者35例,拟诊者17例。其发生时间为移植后2～400d,中位时间为62d。确诊 IFI 在移植后3、6个月及1年的累积发病率分别为15.6%、42.5%、48.9%。根据多因素分析,早期 IFI 的危险因素为:Ⅲ～Ⅳ度的急性移植物抗宿主病(GVHD)、广谱抗生素的长期应用及巨细胞病毒感染;晚期 IFI 的危险因素为:广泛型慢性 GVHD和激素的长期应用。结论具有较多危险因素的 HSCT 受者更易发生 IFI,而避免或减少上述危险因素是预防 IFI 的有效方法。
Objective To investigate the incidence and risk factors of invasive fungal infection (IFI) after hematopoietic stem cell transplantation (HSCT). Methods A total of 148 HSCT patients from June 2003 to September 2004 were retrospectively analyzed according to the diagnostic criteria and clinical efficacy of IFI in China. Results A total of 52 patients with IFI were diagnosed, of which 35 were diagnosed and 17 were diagnosed. The occurrence of 2 ~ 400d after transplantation, the median time was 62d. The cumulative incidence of diagnosed IFI at 3, 6 months and 1 year after transplantation was 15.6%, 42.5% and 48.9%, respectively. According to multivariate analysis, the risk factors for early IFI were grade III-IV acute graft-versus-host disease (GVHD), long-term use of broad-spectrum antibiotics and cytomegalovirus infection. The risk factors for advanced IFI were generalized chronic GVHD And long-term use of hormones. Conclusion HSCT recipients with more risk factors are more likely to develop IFI. To avoid or reduce these risk factors is an effective way to prevent IFI.