發(fā)布時間：2018-06-22 21:28

  本文選題：造血干細胞移植 + 感染　； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的探討造血干細胞移植(Hematopoietic stem cells transplantation, HSCT)后不同時期并發(fā)感染的臨床特征,為經(jīng)驗性防治HSCT后感染并發(fā)癥提供依據(jù)。方法回顧性分析我院(蘇州大學(xué)附屬第一醫(yī)院)血液科2013年381例HSCT患者移植后感染的發(fā)生率、病原菌分布及感染相關(guān)因素。結(jié)果1、干細胞移植術(shù)后0-180天感染累積發(fā)生率為84.2%,發(fā)生中位時間為移植后+22(0-180)天。0-30天(早期)、30-100天(中期)、100-180天(晚期)感染發(fā)生率分別為61.2%、65.6%、26.1%。2、HSCT后0-180天共檢測出168株細菌,0-30天檢測陽性菌株占50.0%(84/168)。HSCT后0-180天血流感染陽性菌株83株,0-30天檢測陽性菌株占80.7%(67/83),其中革蘭陰性菌占72.3%(60/83),革蘭陽性菌占27.7%(23/83)。血流感染陽性菌株中多藥耐藥菌(Multiple drug resistant bacterial, MDR)51株(占61.4%),以革蘭陰性菌為主(76.5%)。細菌感染中0-30天MDR菌株比例為59.5%,30-100天MDR菌株比例為77.1%,100-180天MDR菌株比例為78.5%。3、HSCT病毒感染主要發(fā)生于30-100天,0-180天巨細胞病毒(Cytomegalovirus, CMV)、EB病毒(Epstein-barr virus, EBV)感染累積發(fā)生率分別為26.5%、20.5%,其中血清CMV-PP65或CMV-DNA定量陽性118例,EBV-DNA定量陽性82例。4. HSCT后0-30天、30-100天、100-180天侵襲性真菌感染(Invasive fungal infection, IFI)發(fā)生率分別為5.2%(20/381)、7.9%(26/331)、3.0%(9/303)。0-180天確診IFI例數(shù)占0.1%(1/1015),臨床診斷IFI占3.2%(32/1015),擬診IFI占2.2%(22/1015)。5、本研究對HSCT患者性別、年齡(≥40歲或40歲)、疾病種類、移植類型、人類白細胞抗原(Human leukocyte antigen, HLA)配型、預(yù)處理方案(清髓或非清髓)、抗胸腺細胞球蛋白(Antithymocyte globulin, ATG)/抗淋巴細胞球蛋白(Antilymphocyte globulin, ALG)應(yīng)用及移植物抗宿主病(Graft-versus-host disease, GVHD)等相關(guān)因素進行統(tǒng)計學(xué)分析,多因素分析(Lodistic回歸)結(jié)果示：ATG/ALG應(yīng)用、Ⅱ-Ⅳ度aGVHD是早期感染發(fā)生的獨立危險因素；ATG/ALG應(yīng)用、HLA配型半相合、Ⅱ-Ⅳ度aGVHD是中期感染發(fā)生的獨立危險因素；cGVHD是晚期感染發(fā)生的獨立危險因素。結(jié)論造血干細胞移植術(shù)后感染以細菌感染為主,往往伴有病毒、真菌混合感染,細菌感染主要為革蘭陰性桿菌,且多為多藥耐藥菌；移植后期感染率雖然明顯下降,但MDR菌株比例顯著上升；移植后病毒感染主要發(fā)生在30-100天,真菌感染多貫穿于移植后各時期,以早中期為主；ATG/ALG應(yīng)用、HLA配型不合、GVHD發(fā)生及程度是HSCT術(shù)后感染發(fā)生的獨立危險因素。
[Abstract]:Objective to investigate the clinical features of infection after hematopoietic stem cell transplantation (HSCT) at different stages, and to provide evidence for empirical prevention and treatment of infection complications after hematopoietic stem cell transplantation (HSCT). Methods the incidence of infection, the distribution of pathogenic bacteria and the related factors of infection in 381 HSCT patients in our hospital (the first affiliated Hospital of Suzhou University) in 2013 were analyzed retrospectively. Results 1. The cumulative infection rate of 0-180 days after stem cell transplantation was 84.2. The median time of infection was 22 (0-180) days, 0-30 days (early) 30-100 days (metaphase) and 100-180 days (late stage) of stem cell transplantation. The incidence of infection was 61.2%, 65.60.26.1.2HSCT 0-180 days after transplantation, 168 strains of bacteria were detected. 80.7% (67 / 83) of positive strains were detected 0-30 days after HSCT. 72.3% (60 / 83) of Gram-negative strains and 27.7% (23 / 83) of Gram-positive bacteria. Among the positive strains of blood stream infection, 51 strains (61.4%) were multiple drug resistant bacterial, MDR, and 76.5% (76.5%) were Gram-negative strains. The proportion of MDR strains from 0-30 days to 100 days after bacterial infection was 59.5% and 30-100 days respectively, and the proportion of MDR strains was 77.1% and 100-180 days. The proportion of MDR strains was 78.5%. 3% HSCT virus infection occurred mainly in 30-100 days and 0-180 days of Cytomegalovirus virus (CMV) Epstein-Barr virus (EBV) infection cumulative incidence was 26.5T 20.5T, respectively. CMV-PP65 or CMV-DNA quantitative positive in 118 patients with EBV-DNA quantitative positive in 82 cases. The incidence of invasive fungal infection (IFI) was 5.2% (20 / 381) or 7.9% (26 / 331), 0.1% (1 / 1015), 3.2% (32 / 1015) and 2.2% (22 / 1015), respectively. Human leukocyte antigen-matching, pretreatment regimen (myeloablative or non-myeloablative), antithymocyte globulin (Antithymocyte globulin,) / antilymphocyte globulin (Antilymphocyte globulin,) and graft-versus-host disease (GVHD) were analyzed statistically. The results of multivariate analysis (Lodistic regression) showed that grade 鈪，

本文編號：2054282