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目的探讨血液病伴肺部侵袭性真菌病(IFD)病史患者行异基因造血干细胞移植(allo-HSCT)后其肺部IFD的复发、疗效及影响因素。方法2005年3月至2006年10月南方医科大学南方医院14例肺部IFD病史的血液病患者接受allo-HSCT,移植前经抗真菌治疗10例完全缓解(CR),4例部分缓解(PR),移植中均给予预防性抗真菌治疗。调查移植后肺部IFD的复发、疗效,IFD相关病死率,Logistic回归模型分析移植方式、移植前IFD状态、预处理方案、移植物抗宿主病(GVHD)预防方案[含抗胸腺球蛋白(ATG)和不含ATG]、供受关系、急性GVHD(aGVHD)及WBC重建对移植后肺部IFD转归的影响。结果移植后肺部IFD的复发率为71.4%(10/14),移植前10例CR患者6例复发,4例PR患者全部复发;其复发时间分别为移植后3个月内7例,4~6个月内3例;10例复发患者中9例接受抗真菌治疗后4例获CR,2例PR,3例无效(NR),总有效率为6/9;移植后IFD相关病死率为35.7%(5/14);二性霉素B、伊曲康唑及伏立康唑预防肺部IFD的复发率差异无显著性意义(P=0.122);经Logisitic回归分析未发现与移植后肺部IFD复发相关的危险因素及影响其转归的危险因素。结论肺部IFD病史不是allo-HSCT的绝对禁忌证;有肺部IFD病史的患者,其移植后IFD复发率及相关病死率高。
Objective To investigate the relapse, efficacy and influential factors of pulmonary IFD in patients with hematologic disease and pulmonary invasive fungal disease (IFD) after allo-HSCT. Methods From March 2005 to October 2006, 14 patients with hematologic diseases with pulmonary IFD in Nanfang Hospital of Southern Medical University underwent allo-HSCT. Ten patients with complete remission (CR) and 4 patients with partial remission (PR) ), Were given prophylactic antifungal therapy. Investigate the relapse, efficacy, IFD-related mortality of lung-related IFD after transplantation, Logistic regression model to analyze the mode of transplantation, pre-transplant IFD status, pretreatment protocol, GVHD prophylaxis [Anti-thymoglobulin ) And non-ATG] for the impact of relapse, acute GVHD (aGVHD), and WBC reconstruction on outcomes of lung-grafted IFD after transplantation. Results The recurrence rate of pulmonary IFD was 71.4% (10/14) after transplantation in 6 cases, 6 cases of CR in 10 cases before transplantation and 4 cases in PR. The recurrence time was 7 cases in 3 months after transplantation, 4 cases ~ 6 months in 3 cases; 9 out of 10 recurrent patients received antifungal therapy after 4 cases were CR, 2 cases of PR, 3 cases of ineffective (NR), the total effective rate was 6/9; IFD-related mortality after transplantation Was 35.7% (5/14). There was no significant difference in the relapse rate of amphotericin B, itraconazole and voriconazole in the prevention of pulmonary IFD (P = 0.122). Logistic regression analysis showed no correlation with pulmonary fibrosis Risk factors associated with recurrence of IFD and risk factors affecting their outcome. Conclusions The history of pulmonary IFD is not an absolute contraindication to allo-HSCT. Patients with a history of pulmonary IFD have a high IFD recurrence rate and related mortality after transplantation.