中性粒细胞减少症合并侵袭性肺曲霉病患者的免疫重建炎症综合征。

Immune reconstitution inflammatory syndrome in neutropenic patients with invasive pulmonary aspergillosis.

机构信息

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.

Division of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea.

出版信息

J Infect. 2015 Jun;70(6):659-67. doi: 10.1016/j.jinf.2014.12.020. Epub 2015 Jan 15.

DOI:10.1016/j.jinf.2014.12.020

PMID:25597823

Abstract

OBJECTIVES

Clinical and radiologic deterioration is sometimes observed during neutrophil recovery in patients with invasive pulmonary aspergillosis (IPA). This deterioration can be caused by immune reconstitution inflammatory syndrome (IRIS) as well as by progression of the IPA. However, there is limited data on IRIS in neutropenic patients.

METHODS

Over a 6-year period, adult patients with neutropenia who met the criteria for probable or proven IPA by the revised EORTC/MSG definition were retrospectively enrolled. IRIS was defined as de novo appearance or worsening of radiologic pulmonary findings temporally related to neutrophil recovery, with evidence of a decrease of 50% in serum galactomannan level.

RESULTS

Of 153 patients, 36 (24%, 95% CI 18%-31%) developed IRIS during neutrophil recovery. More of these patients received voriconazole than did those with non-IRIS (42% vs. 25%, P = 0.05). Thirty- and ninety-day mortalities were lower in the patients with IRIS than in those with non-IRIS (11% vs. 33%, P = 0.01, and 33% vs. 58%, P = 0.01, respectively).

CONCLUSION

IRIS is relatively common among neutropenic patients with IPA, occurring in about one quarter of such patients. It is associated with voriconazole use and has a good prognosis.

摘要

目的

侵袭性肺曲霉病（IPA）患者中性粒细胞恢复期间有时会观察到临床和影像学恶化。这种恶化可能是由免疫重建炎症综合征（IRIS）以及 IPA 的进展引起的。然而，中性粒细胞减少症患者的 IRIS 数据有限。

方法

在 6 年期间，回顾性纳入符合修订后的 EORTC/MSG 定义的疑似或确诊 IPA 的中性粒细胞减少症成年患者。IRIS 的定义为中性粒细胞恢复时新出现或恶化的放射学肺部表现，与血清半乳甘露聚糖水平下降 50%有关。

结果

在 153 例患者中，36 例（24%，95%CI 18%-31%）在中性粒细胞恢复期间发生 IRIS。与非 IRIS 患者相比，这些患者中接受伏立康唑治疗的患者更多（42%比 25%，P=0.05）。IRIS 患者的 30 天和 90 天死亡率低于非 IRIS 患者（11%比 33%，P=0.01，33%比 58%，P=0.01）。