摘要
目的:分析异基因造血干细胞移植后早期结核分枝杆菌感染的患病率、临床特征、诊断、治疗及预后。方法:对我院连续接受异基因造血干细胞移植的258例患者中确诊为结核分枝杆菌感染的6例患者进行回顾性分析及总结。结果:结核病的发生率为2.32%(6/258),在单倍型、非血缘、同胞相合移植3种不同移植方式中发生率分别为1.90%、1.70%、2.98%,差异无统计学意义(P>0.05)。结核感染临床类型:结核性脑膜炎1例、结核性胸膜炎1例、结核性腹膜炎1例、淋巴结结核2例、肺结核1例。发病的中位时间为+83(+28～+138)d,从出现症状到确诊的中位时间为24(11～32)d。多以长时间不明原因的不规则发热为首要表现,伴全身结核中毒症状。6例患者中5例经临床症状、实验室检查阳性、排除结核以外的感染、诊断性抗结核治疗有效而确诊;1例经痰抗酸杆菌强阳性而确诊。5例均采用4联或3联[INF加RFP加PZA和(或)EMB]常规抗结核治疗,其中2例完成足疗程抗结核治疗者存活,3例治疗有效后因为经济原因放弃治疗。1例患者在诊断前死亡。结论:异基因造血干细胞移植后早期要重视结核分枝杆菌感染发生,早诊断、早治疗;由于临床表现隐匿缺乏特异性,常规检查手段检出率低,易造成误诊及漏诊、诊断依赖于综合手段;临床表现或感染类型多样化,接受正规治疗者治疗反应好;如果并发移植物抗宿主病,合理用药是提高疗效的关键;应该重视对高危人群进行移植前结核筛查及移植后的结核预防。
Objective：To analyze the incidence,clinical characteristics,diagnosis,treatment and prognosis of tuberculous infections following allogeneic hematopoietic stem cell transplantation（allo-HSCT）.Method：Six cases with tuberculous infection were confirmed among 258 recipients underwent allo-HSCT who were admitted to our institution.Their clinical data were retrospectively collected and analyzed..Result：Tuberculous infections occurred in six patients of 258 cases following allo-HSCT.The overall incidence was 2.32%.The incidences were not significantly different.among haploid,unrelated and sibling transplantation.The types of tuberculous infection were various.There were one case of tuberculous meningitis,one case of tuberculous pleurisy,one case of tuberculous peritonitis,two cases of tuberculous lymphadenitis and one case of pulmonary tuberculosis.The median duration of tuberculous presentation after transplantation was 83 days（range 28-138 d）.The median time from symptoms onset to diagnosis was 24 days（range 11-32 d）.The first and major clinical manifestation were fever with no reasons for long time complicated with tuberculous toxic symptoms.Five cases were diagnosed with special clinical symptom,positively laboratory examinations and imaging studies,exclusion of other opportunistic infections and clinical response to antituberculosis drugs.One patient was diagnosed with positive acid-fast bacilli in sputum smears.Five patients were treated with combination of three or four standard antituberculosis drugs（INF＋RFP＋PZA and/or EMB）.Among these five patients,two patients received full time therapy for seven months and survived,three gained clinical response to antituberculosis drugs but gave up treatments because of economical reason.One patient died before diagnosis.Conclusion：The cellular immunity of HSCT recipients is extremely disrupted thus these patients have high incidence of opportunistic infections.It should be noticed that tuberculous infections can occur in the early stage of HSCT,
出处
《临床血液学杂志》
CAS
2011年第4期391-393,396,共4页
Journal of Clinical Hematology
