Wang Zhi-Yong, Jiang Er-Lie, Zhang Ping, Wang Hua, Bao Yu-Shi, Wang Mei, Feng Si-Zhou, Han Ming-Zhe
Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2008 Jun;16(3):618-22.
In order to analyze the incidence and high-risk factors of invasive fungal infections among recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT), 180 cases of allo-HSCT were enrolled in this study. The incidence and risk factors of IFI were analyzed by method of Kaplan-Meier and Cox regression model. The results showed that an incidence of IFI in 35 cases (19.5%) were detected, with 1 case proven and 34 cases probably diagnosed, which was composed of 18 cases (51.4%) of aspergillosis and 17 cases (48.6%) of candidosis. There was significant difference in one-year overall survival rate between patients with (34.3%) or without (53.8%) IFI. In univariate analysis, risk factors of IFI included: pretransplant fungal infection or colonization, unrelated donor (peripheral blood or bone marrow stem cell) transplantation, acute GVHD, extensive chronic GVHD and the use of methylprednisolone. In multi-variate analysis, the following risk factors of IFI were found:unrelated donor for allogeneic peripheral blood or bone marrow stem cell transplantation, acute GVHD and pretransplant fungal infection or colonization acute GVHD (RR: 2.399, 1.589, and 0.836). It is concluded that IFI is a frequent complication and one of the leading causes of mortality among recipients of allo-HSCT. As for patients with higher risk of IFI, early interventions should be taken.
为分析异基因造血干细胞移植（allo-HSCT）受者侵袭性真菌感染的发生率及高危因素，本研究纳入180例allo-HSCT患者。采用Kaplan-Meier法和Cox回归模型分析IFI的发生率及危险因素。结果显示，共检测到35例（19.5%）IFI，其中确诊1例，拟诊34例，包括曲霉病18例（51.4%）和念珠菌病17例（48.6%）。发生IFI的患者与未发生IFI的患者1年总生存率差异有统计学意义（分别为34.3%和53.8%）。单因素分析显示，IFI的危险因素包括：移植前真菌感染或定植、非血缘供者（外周血或骨髓干细胞）移植、急性移植物抗宿主病（GVHD）、广泛慢性GVHD及使用甲泼尼龙。多因素分析发现，IFI的危险因素如下：异基因外周血或骨髓干细胞移植的非血缘供者、急性GVHD及移植前真菌感染或定植急性GVHD（风险比：2.399、1.589和0.836）。结论是，IFI是allo-HSCT受者常见的并发症和主要死亡原因之一。对于IFI高危患者，应尽早采取干预措施。
