Morrison V A, Haake R J, Weisdorf D J
Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis.
Am J Med. 1994 Jun;96(6):497-503. doi: 10.1016/0002-9343(94)90088-4.
To determine the incidence, risk factors, and outcome of non-Candida fungal infections in a bone marrow transplant population.
A consecutive series of 1,186 patients who underwent bone marrow transplant at the University of Minnesota Hospital between 1974 and 1989 were analyzed for the occurrence of a post-transplant non-Candida fungal infection. The risk factors were analyzed with regard to clinical characteristics such as age, sex, primary disease process, type of transplant, recipient cytomegalovirus serostatus, time to engraftment, and the presence of graft-versus-host disease.
In this population, 123 of 1,186 patients (10%) developed a non-Candida fungal infection within 180 days of transplant. The majority of infections (85%) occurred in allogeneic recipients, and 58% of infections were prior to white blood cell engraftment. The most common isolates were Aspergillus species (70%), Fusarium species (8%), and Alternaria species (5%). Although 47% of infections involved a single organ or site, 44% were disseminated and 9% were isolated fungemias. Only 17% of patients survived. Sixty-eight percent of deaths were related to the fungal infection. In univariate analysis, allogeneic transplant, positive recipient cytomegalovirus serostatus, delayed engraftment, and recipient age of greater than or equal to 18 years were identified as risk factors for non-Candida fungal infection. All of these factors except for recipient age were independently significant in multivariate analysis. In allogeneic recipients, positive cytomegalovirus serostatus, delayed engraftment, and age of greater than or equal to 18 years were each significantly associated with a greater risk of fungal infection; none of these factors were independently significant in the autologous recipients.
Fungal infections remain a major cause of morbidity and mortality in patients undergoing bone marrow transplant. More effective antifungal prophylaxis and therapy, earlier diagnosis, and transplant regimens incurring a brief period of neutropenia may substantially reduce the incidence and clinical impact of these infections.
确定骨髓移植人群中非念珠菌属真菌感染的发生率、危险因素及预后。
对1974年至1989年间在明尼苏达大学医院接受骨髓移植的1186例连续患者进行分析，以了解移植后非念珠菌属真菌感染的发生情况。针对年龄、性别、原发疾病进程、移植类型、受者巨细胞病毒血清学状态、植入时间以及移植物抗宿主病的存在等临床特征分析危险因素。
在该人群中，1186例患者中有123例（10%）在移植后180天内发生了非念珠菌属真菌感染。大多数感染（85%）发生在异基因受者中，58%的感染发生在白细胞植入前。最常见的分离菌是曲霉菌属（70%）、镰刀菌属（8%）和链格孢属（5%）。虽然47%的感染累及单一器官或部位，但44%为播散性感染，9%为孤立性真菌血症。只有17%的患者存活。68%的死亡与真菌感染有关。单因素分析中，异基因移植、受者巨细胞病毒血清学阳性、植入延迟以及受者年龄大于或等于18岁被确定为非念珠菌属真菌感染的危险因素。除受者年龄外，所有这些因素在多因素分析中均具有独立显著性。在异基因受者中，巨细胞病毒血清学阳性、植入延迟以及年龄大于或等于18岁均与真菌感染风险增加显著相关；在自体受者中，这些因素均无独立显著性。
真菌感染仍然是接受骨髓移植患者发病和死亡的主要原因。更有效的抗真菌预防和治疗、早期诊断以及导致短暂中性粒细胞减少期的移植方案可能会大幅降低这些感染的发生率和临床影响。
