摘要
目的 了解多发性骨髓瘤（MM）自体造血干细胞移植（ASCT）后感染的临床特点.方法 回顾性分析在中山大学附属第一医院住院诊治并接受ASCT治疗的37例MM患者,记录移植后6个月内的感染类型、时间、病原体以及疗效和转归.结果 在ASCT后6个月内有33例（89.2%）患者在观察期间出现59例次感染,其中30例患者在观察期间出现34例次（57.6%）细菌感染,12例患者在观察期间出现15例次（25.4%）真菌感染.既往曾合并真菌感染患者在移植后发生真菌感染比例高于没有合并真菌感染的患者（P=0.040）.观察期间分别出现4例（6.8%）巨细胞病毒（CMV）、3例（5.1%）带状疱疹病毒感染及3例（5.1%）HBV再激活.移植后早期感染中细菌感染占62.8%,真菌感染28.6%,病毒感染8.6%,其中病毒感染均为CMV感染,移植后早期未见水痘带状疱疹病毒和HBV感染.移植后中期感染中细菌感染占50.0%、真菌感染20.8%、病毒感染29.3%,移植后早期与中期感染比例差异无统计学意义（P=0.106）.38例次（64.4%）感染在应用首选抗感染治疗即得到控制.3例（8.1%）由于感染相关死亡.结论 MM患者ASCT后感染发生率高,各种病原体均易感,需要尽早合理抗感染治疗,降低感染相关病死率.
Objective To explore the clinical features of infection in multiple myeloma （MM）undergoing autologous hematopoietic stem cell transplantation （ASCT）. Methods Thirty-seven patients with MM undergoing ASCT were retrospectively analyzed for type and time of infection, pathogen, and outcome. Results Fifty-nine cases of infectious complications occurred in 33 patients （89. 2% ） after ASCT, with 34 cases （57.6%） of bacterial infections in 30 patients, 15 cases （25.4%） of fungal infections in 12 patients, 4 cases （6. 8% ） of cytomegalovirus （CMV） infection, 3 cases （5. 1% ） of herpes zoster virus infection and 3 cases （5. 1% ） of HBV reactivation. The proportion of bacterial infection, fungal infection and virus infection were 62. 8%, 28.6% and 8. 6% respectively in the early stage after ASCT, and 50. 0%, 20. 8% and 29. 3% respectively in the median stage. Response to first-line antibiotic therapy was seen in 38 cases （64. 4% ）. Infection-related mortality was 8. 1% （3 cases）. Conclusions The incidence of infection in MM patients undergoing ASCT is high and they are susceptible to all pathogens. It is important to choose the right antifungal agents as quickly as possible to reduce infection-related mortality.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2011年第1期44-47,共4页
Chinese Journal of Internal Medicine
关键词
多发性骨髓瘤
造血干细胞移植
感染
Multiple myeloma
Hematopoietic stem cell transplantation
Infection
