Hovi L, Saarinen-Pihkala U M, Vettenranta K, Saxen H
Hospital for Children and Adolescents, University of Helsinki, Finland.
Bone Marrow Transplant. 2000 Nov;26(9):999-1004. doi: 10.1038/sj.bmt.1702654.
Invasive fungal infections (IFI) with substantial mortality constitute an increasing problem among BMT patients. From 1986 to 1996 148 children underwent BMT, and are included in a retrospective analysis of the incidence, risk factors and outcome of IFI. By histopathology or culture-proven IFI (Candida, 10; Aspergillus, 8) was documented in 12/73 (16%) allogeneic and in 6/75 (8%) autologous BMT patients. Of these 18 patients, 15 subsequently died, and in 12 (66%) IFI was regarded as the main cause of death. In addition to the patients with documented IFI, 48 had suspected and 82 no fungal infection. Invasive candidal infections were more frequent in patients with semiquantitatively estimated abundant candidal colonization as compared with those with no colonization (18% vs 3%, P = 0.015). In the allogeneic group, 50% of those with severe (grades III-IV) aGVHD had IFI as opposed to 8% of those with no or mild aGVHD (P < 0.001). Regarding cGVHD, 57% of those with extensive cGVHD vs 5% of those with absent or limited cGVHD had IFI (P < 0.001). The dose of steroids was associated with IFI: 77% of those who received high-dose steroids (methylprednisolone 0.25-1 g/day for 5 days) vs 5% of those with conventional-dose (prednisone 2 mg/kg/day) had IFI (P < 0.001). Particularly for BMT patients at risk, new, quicker and better diagnostic tests and more effective anti-fungal agents, both for prophylaxis and treatment, are needed.
侵袭性真菌感染（IFI）导致的死亡率很高，这在骨髓移植（BMT）患者中已成为一个日益严重的问题。1986年至1996年间，148名儿童接受了BMT，并纳入了一项关于IFI发病率、危险因素和预后的回顾性分析。经组织病理学或培养证实的IFI（念珠菌10例；曲霉菌8例）在12/73（16%）的异基因BMT患者和6/75（8%）的自体BMT患者中得到记录。在这18例患者中，15例随后死亡，其中12例（66%）的IFI被视为主要死因。除了有记录的IFI患者外，48例有疑似真菌感染，82例无真菌感染。与无念珠菌定植的患者相比，半定量估计有大量念珠菌定植的患者侵袭性念珠菌感染更常见（18%对3%，P = 0.015）。在异基因组中，重度（III-IV级）急性移植物抗宿主病（aGVHD）患者中有50%发生IFI，而无aGVHD或轻度aGVHD患者中这一比例为8%（P < 0.001）。关于慢性移植物抗宿主病（cGVHD），广泛cGVHD患者中有57%发生IFI，而无cGVHD或局限性cGVHD患者中这一比例为5%（P < 0.001）。类固醇剂量与IFI有关：接受高剂量类固醇（甲基泼尼松龙0.25 - 1 g/天，共5天）的患者中有77%发生IFI，而接受常规剂量（泼尼松2 mg/kg/天）的患者中这一比例为5%（P < 0.001）。特别是对于有风险的BMT患者，需要新的、更快且更好的诊断测试以及更有效的抗真菌药物用于预防和治疗。
