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目的了解儿童异基因造血干细胞移植的感染率和特点。方法对上海儿童医学中心从2002年11月到2004年8月共18例异基因造血干细胞移植的血液肿瘤患儿,发生移植后感染的所有病例进行回顾性分析。结果18例异基因造血干细胞移植患儿,发生细菌、真菌感染的13例,感染率为72·2%;在28株分离菌中,革兰阳性菌14株,革兰阴性菌8株和真菌6株。主要细菌为凝固酶阴性葡萄球菌、肠球菌属、大肠埃希氏菌和克雷伯菌属,且大多数细菌耐药。实时定量PCR监测移植后人类巨细胞病毒(HCMV)感染发现:有16例患儿发生至少一次的HCMV感染,感染率为88·9%。结论感染是儿童异基因造血干细胞移植术后主要的并发症,临床早期诊断、定期监测、及时地合理治疗对降低移植术后感染和提高移植成功率至关重要。
Objective To understand the infection rate and characteristics of children with allogeneic hematopoietic stem cell transplantation. Methods A total of 18 children with hematological malignancies allogeneic hematopoietic stem cell transplantation from November 2002 to August 2004 in Shanghai Children’s Medical Center were retrospectively analyzed for all cases of posttransplant infection. Results Of the 18 children with allogeneic hematopoietic stem cell transplantation, 13 cases of bacterial and fungal infection were found, the infection rate was 72.2%. Of 28 isolates, 14 were gram-positive bacteria, 8 gram-negative bacteria and fungi 6 strains. The main bacteria are coagulase-negative Staphylococcus, Enterococcus, Escherichia coli and Klebsiella, and most of the bacteria are resistant. Real-time quantitative PCR monitoring of human cytomegalovirus (HCMV) infection after transplantation revealed that HCMV infection occurred in at least one of 16 children at a rate of 88.9%. Conclusion Infection is a major complication after allogeneic hematopoietic stem cell transplantation in children. Early clinical diagnosis, regular monitoring and timely and reasonable treatment are very important to reduce the infection after transplantation and improve the success rate of transplantation.