摘要
侵袭性真菌感染在造血干细胞移植患者中发病率及病死率均很高。近年来由于移植方式的改进及积极的预防治疗,其流行病学发生了显著的变化。侵袭性曲霉菌感染是造血干细胞移植患者主要的真菌感染,主要发生在移植后晚期。移植患者存在粒细胞缺乏、移植物抗宿主病、应用免疫抑制剂等诸多危险因素,且病理组织学标本难以获取及血培养阳性率低、时间长及诊断困难,故侵袭性真菌感染导致的死亡率仍然很高。目前高分辨CT、PET/CT及非培养的诊断试验如GM试验、G试验等均已应用于临床,真菌PCR诊断技术也不断进展,有助于实现早期特异性诊断。高效低毒的新药如伏立康唑、卡泊芬净、米卡芬净等正逐渐用于预防,联合用药及免疫治疗也有望成为新的治疗策略。本文就近年来造血干细胞移植患者侵袭性真菌感染的流行病学变化、危险因素、诊断和治疗进展作一综述。
Invasive fungal infections（IFI） are associated with considerable morbidity and mortality after hematopoietic stem cell transplantation（HSCT）.Recently,the epidemiology of IFI has changed notably by evolution in transplantation procedures as well as preventative strategies.Invasive Aspergillosis is the major fungal infection in the patients undergoing HSCT,which mainly occurred during later period of post-HSCT.With the risk factors,such as prolonged neutropenia,graft-versus-host disease and adopted immunosuppressants and so on in HSCT patients,moreover there are the difficult acquirement of histopathological specimen and time consuming,few positive blood culture,the attributable mortality still remains high.Hence high-resolution computed tomography,PET/CT and non-culture based adjunctive diagnostic tests,such as enzyme-linked immunosorbent assay for galactomannan（GM） and（1,3）-β-D-glucan have been incorporated into clinical practice,while the molecular detection,like fungal PCR assays have been developed and will bring the ealier,specific diagnosis for IFI.Newer agents with higher efficacy and lower toxicity,such as voriconazole,caspofungin and micafungin are currently being introduced as prophylaxis,while the combination of these agents and immunotherapy are evaluated to be more prospective strategies.This review summarizes the changed epidemiology,risk factors and recent advances in the diagnosis and management of IFI in HSCT recipients.
出处
《中国实验血液学杂志》
CAS
CSCD
2011年第2期517-522,共6页
Journal of Experimental Hematology
基金
首都医学科研发展基金
编号2007-2040
关键词
侵袭性真菌感染
造血干细胞移植
流行病学
危险因素
invasive fungal infections
hematopoietic stem cell transplantation
epidemiology
risk factors
