CAJ | 학술논문

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.
목적 료해다발성골수류(MM)자체조혈간세포이식(ASCT)후감염적림상특점.방법 회고성분석재중산대학부속제일의원주원진치병접수ASCT치료적37례MM환자,기록이식후6개월내적감염류형、시간、병원체이급료효화전귀.결과 재ASCT후6개월내유33례(89.2%)환자재관찰기간출현59례차감염,기중30례환자재관찰기간출현34례차(57.6%)세균감염,12례환자재관찰기간출현15례차(25.4%)진균감염.기왕증합병진균감염환자재이식후발생진균감염비례고우몰유합병진균감염적환자(P=0.040).관찰기간분별출현4례(6.8%)거세포병독(CMV)、3례(5.1%)대상포진병독감염급3례(5.1%)HBV재격활.이식후조기감염중세균감염점62.8%,진균감염28.6%,병독감염8.6%,기중병독감염균위CMV감염,이식후조기미견수두대상포진병독화HBV감염.이식후중기감염중세균감염점50.0%、진균감염20.8%、병독감염29.3%,이식후조기여중기감염비례차이무통계학의의(P=0.106).38례차(64.4%)감염재응용수선항감염치료즉득도공제.3례(8.1%)유우감염상관사망.결론 MM환자ASCT후감염발생솔고,각충병원체균역감,수요진조합리항감염치료,강저감염상관병사솔.
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.