CAJ | 학술논문

　　目的观察移植前肺部感染对血液病造血干细胞移植疗效的影响。方法回顾性分析1999年8月-2012年3月我院21例血液病患者造血干细胞移植前出现肺部感染经治疗后接受造血干细胞移植的疗效，其中急性淋巴细胞白血病7例、急性非淋巴细胞白血病10例、骨髓增生异常综合征2例、急性再生障碍性贫血2例。接受异基因造血干细胞移植20例，1例接受自体造血干细胞移植。移植前肺部感染均为深部真菌感染或混合感染，抗真菌治疗后病灶消失或缩小至稳定时进行移植，肺部还有残存病症移植期间持续抗真菌治疗，病灶消失的预处理后给予抗真菌次级预防。结果21例移植后28 d骨髓均增生活跃，骨髓像完全缓解，其中异基因造血干细胞移植嵌合体均为100%供者型。移植后14例未出现新的肺部感染，其中1例因白血病复发死亡；7例肺部感染加重，考虑为侵袭性深部真菌感染，经抗真菌治疗1~2个月后痊愈2例，显效3例；肺部感染恶化死亡2例，其中1例白血病复发。结论肺部感染的血液病患者经有效抗感染治疗，依然可以行造血干细胞移植；肺部真菌感染对造血干细胞移植成功率无明显影响。
　　목적관찰이식전폐부감염대혈액병조혈간세포이식료효적영향。방법회고성분석1999년8월-2012년3월아원21례혈액병환자조혈간세포이식전출현폐부감염경치료후접수조혈간세포이식적료효，기중급성림파세포백혈병7례、급성비림파세포백혈병10례、골수증생이상종합정2례、급성재생장애성빈혈2례。접수이기인조혈간세포이식20례，1례접수자체조혈간세포이식。이식전폐부감염균위심부진균감염혹혼합감염，항진균치료후병조소실혹축소지은정시진행이식，폐부환유잔존병증이식기간지속항진균치료，병조소실적예처리후급여항진균차급예방。결과21례이식후28 d골수균증생활약，골수상완전완해，기중이기인조혈간세포이식감합체균위100%공자형。이식후14례미출현신적폐부감염，기중1례인백혈병복발사망；7례폐부감염가중，고필위침습성심부진균감염，경항진균치료1~2개월후전유2례，현효3례；폐부감염악화사망2례，기중1례백혈병복발。결론폐부감염적혈액병환자경유효항감염치료，의연가이행조혈간세포이식；폐부진균감염대조혈간세포이식성공솔무명현영향。
Objective To observe the effect of pulmonary infection on hematopoietic stem cell transplantation. Methods Effect of hematopoietic stem cell transplantation on pulmonary infection in 21 patients with hematopathy admitted to our hospital from August 1999 to March 2012 was retrospectively analyzed. Of these 21 patients, 7 were diagnosed as acute lymphocytic leukemia, 10 as acute non-lymphocytic leukemia, 2 as myeloproliferative syndrome, and 2 as acute aplastic anemia, and 20 received allogeneic hematopoietic stem cell transplantation and 1 received autologous hematopoietic stem cell transplantation. All the patients were diagnosed as deep fungal infection or mixed infection and underwent hematopoietic stem cell transplantation when their lesions disappeared or became smaller after anti-fungal therapy. Results Twenty-eight days after hematopoietic stem cell transplantation, the bone marrow proliferated actively in the 21 patients with their myelopathy completely alleviated. The chimera was 100%donor type after allogeneic hematopoietic stem cell transplantation. Fourteen days after hematopoietic stem cell transplantation, no new pulmonary infection occurred in 14 patients with 1 died of recurrent leukemia, pulmonary infection was exacerbated in 7 patients with 2 completely cured, 3 significantly improved after antifungal therapy for 1-2 months and 2 died due to exacerbated pulmonary infection. Conclusion Hemapathy patients with pulmonary infection can undergo hematopoietic stem cell transplantation after effective anti-infection treatment. Pulmonary fungal infection shows no significant effect on hematopoietic stem cell transplantation.