摘要
侵袭性真菌感染(invasive fungal infections,IFI)是造血干细胞移植(HSCT)后常见的严重并发症之一,以念珠菌感染和曲霉菌感染最为常见。由于免疫抑制剂的应用、清髓预处理、急性或慢性移植物抗宿主病(GVHD)、广谱抗生素的长期应用、巨细胞病毒(CMV)感染等因素,IFI呈逐渐增多的趋势。侵袭性霉菌感染(invasive mould infection)已成为造血干细胞移植后IFI发病率和死亡率增加的主要原因。IFI早期诊断方法包括临床检查、实验室检测和特征性影像学检查。目前伏立康唑是确诊IFI的一线治疗用药,唑类或两性霉素B联合棘白霉素类抗真菌药也显示出较好治疗效果,有希望成为一项未来的抗真菌治疗策略。本文就造血干细胞移植后IFI的早期临床诊断和治疗问题作一综述。在IFI早期诊断方面讨论了实验室诊断技术,包括GM试验,G试验和PCR技术等;在IFI预防和治疗方面讨论了预防治疗,经验治疗,优先治疗,确诊后治疗,联合治疗和免疫治疗等。
Invasive fungal infections （IFI） are a kind of the most severe complications after hematopoietic stem cell transplantation （HSCT）, Candida and Aspergillus are common causes. Because of immunosuppressive therapy, ablative conditioning regimen, acute or chronic graft-versus-host disease, long-term treatment of broad-spectrum antibiotics and cytomegalovirus infection, IFI has increased in the past few years. Invasive mould infection is a major cause of morbidi- ty and mortality in HSCT recipients. Methods for early diagnosis of IFI include clinical and laboratory examinations, as well as characteristic radiography. Voriconazole is the first-line antifungal agent for prevention of LFI. Combination therapy of two antifungal compounds such as azoles or amphotericin B with echinocandins have shown a good effectiveness and may be a promising future strategy for antifungal treatment. In this review, the early diagnosis and treatment of IFI in HSCT recipients are summarized. As for early diagnosis of IFI, the laboratory diagnosis techniques such as GM test, G test and PCR techniques are discussed. As for prophylaxis and freatment of IFI, the prophylaxis treatemnt, empirical treatment, preemptive treatment, targeted treatment, combined treatment and immunologic treatment are discussed.
出处
《中国实验血液学杂志》
CAS
CSCD
2009年第6期1619-1623,共5页
Journal of Experimental Hematology
基金
北京市首都医学发展基金资助项目
编号20072040
关键词
侵袭性真菌感染
侵袭性霉菌感染
造血干细胞移植
invasive fungal infection
invasive mould infection
hematopoietic stem cell transplantation
