【摘要】 目的了解异基因造血干细胞移植后感染的经验性治疗现状及影响疗效的因素。方法回顾性分析2007年11月至2010年6月海军总医院105例异基因造血干细胞移植造血重建后近期和远期感染患者各节段抗感染治疗特点及影响疗效的因素。结果各节段抗感染治疗中位时间5～7 d。各节段有效率差异无统计学意义(P>0.05),有效病例的82%均在前两个节段中获得。第二及以后节段中,使用1种和2种药物的治疗组之间有效率均无统计学意义(P>0.05),但均高于使用3种或以上药物的治疗组(P<0.05)。59%的病例使用了抗真菌药物,其中61.3%的病例抗真菌药物持续2个以上节段。抗感染治疗的累积有效率与有无GVHD,是否为急慢性GVHD均无相关性(P>0.05),与免疫抑制剂使用与否,及使用的品种数之间均无相关性(P>0.05),与移植类型也无相关性(P>0.05)。结论前两个节段抗感染治疗最为关键,第二及以后节段中仍"广覆盖"治疗预示疗效不佳,GVHD、免疫抑制剂和移植类型与感染治疗的疗效无相关性。更多还原

【Abstract】 Objective To understand the status of empirical anti-infective therapy post-allo-HSCT and factors related to anti-infective efficacy. Methods The characteristics of anti-infective therapy in each episode and factors related to anti-infective efficacy in 105 infection cases after hematopoietic reconstruction post-allo-HSCT were analyzed retrospectively. Results Range of the anti-infective agents in each episode was 5～7 d.There was no significant difference in response rate among these episodes(P>0.05).82% of responders were proven in first two episodes.Response rates between one-species and two-species group were not different significantly(P>0.05),but they were higher than that in three-species group in second and later episodes(P<0.05).Anti-fungal therapy was performed in 59% of cases and lasted two or more episodes in 61.3% of anti-fungal cases.Accumulated response rate of anti-infective therapy was not associated with graft-versus-host disease,immunosuppressor and the type of transplantation(P>0.05). Conclusion The first two episodes of anti-infective therapy were crucial for infection cases post-allo-HSCT.After the first episode the wide-overlay treatment of anti-infective agents predicted poor prognosis.Accumulated response rate of anti-infective therapy was not related to graft-versus-host-disease,immunosuppressor and the type of transplantation.更多还原