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目的探讨造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后侵袭性真菌病(invasive fungal disease,IFD)的发生率、发病时间、临床表现及治疗效果。方法对军事医学科学院附属医院造血干细胞移植科2000年1月至2006年12月326例行HSCT的病例进行回顾性分析。结果326例行HSCT的患者中39例发生了IFD,发生率为11.9%。确诊9例,临床诊断21例,拟诊9例。39例IFD中,念珠菌病7例,霉菌病32例。HLA相合同胞、无关相合或相关不合及自体HSCT的IFD发生率分别为11.1%(26/234),18.5%(10/54)和7.9%(3/38)。30例出现IFD患者有移植物抗宿主病(graft versus host disease,GVHD)。IFD发生的中位时间78(17~198)d,临床表现主要是发热,广谱抗生素治疗无效,部分患者出现低氧血症。39例中,存活21例,死亡18例,联合抗真菌药物治疗9例患者6例存活。结论IFD是HSCT后的主要死亡原因,无关供者和相关不合的HSCT的IFD发生率明显升高,有GVHD患者发生IFD机会明显增加,联合抗真菌治疗效果有待进一步证实。
Objective To investigate the incidence of invasive fungal disease (IFD) after hematopoietic stem cell transplantation (HSCT), its onset, clinical manifestation and therapeutic effect. Methods A retrospective analysis was performed on 326 cases of HSCT from January 2000 to December 2006 in the Hematopoietic Stem Cell Transplant Unit of the Affiliated Hospital of Military Academy of Medical Sciences. Results Of 326 patients with HSCT, 39 developed IFD, with an incidence of 11.9%. Nine cases were diagnosed, 21 cases were diagnosed clinically and 9 cases were diagnosed clinically. 39 cases of IFD, Candidiasis in 7 cases, mycosis in 32 cases. The IFD rates for HLA-matched siblings, unrelated, or unrelated autologous HSCT were 11.1% (26/234), 18.5% (10/54), and 7.9% (3/38), respectively. Thirty patients with IFD had graft versus host disease (GVHD). IFD median time 78 (17 ~ 198) d, the main clinical manifestations of fever, broad-spectrum antibiotic treatment ineffective, hypoxemia in some patients. Of the 39 patients, 21 survived and 18 died, and 6 of 9 patients treated with antifungal agents survived. Conclusions IFD is the main cause of death after HSCT. The incidence of IFD in unrelated donors and unrelated HSCT patients is significantly increased. The chances of IFD in patients with GVHD are significantly increased. The efficacy of combined antifungal therapy remains to be confirmed.