造血干细胞移植后侵袭性真菌感染的现状与未来

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
李艳，于力
中国人民解放军总医院血液科，北京 100853
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
after Hematopoietic Stem Cell Transplantation ———Review
LI Yan，YU Li
Department of Hematology，Chinese PLA G eneral Hospital，Beijing 100853，China
Corresponding Author: YU Li，Senior Physician，Professor． Tel: ( 010) 66939481． E-mail: chunhuiliyu@ yahoo． com
中国实验血液学杂志 Journal of Experimental Hematology 2011; 19( 2) : 517 － 522
·517·
文章编号( Article ID) : 1009 － 2137( 2011) 02 － 0517 － 06
·综述·
造血干细胞移植后侵袭性真菌感染的现状与未来
来自百度文库
such as voriconazole，caspofungin and micafungin are currently being introduced as prophylaxis，w hile the combination
of these agents and immunotherapy are evaluated to be more prospective strategies． This review summarizes the changed
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
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-
transplantation procedures as w ell as preventative strategies． Invasive Aspergillosis is the major fungal infection in the
patients undergoing HSCT，w hich mainly occurred during later period of post-HSCT． With the risk factors，such as
Abstract
Invasive fungal infections ( IFI ) are associated w ith considerable morbidity and mortality after
hematopoietic stem cell transplantation ( HSCT) ． Recently，the epidemiology of IFI has changed notably by evolution in
glucan have been incorporated into clinical practice，w hile the molecular detection，like fungal PCR assays have been
developed and w ill bring the ealier，specific diagnosis for IFI． New er agents w ith higher efficacy and low er toxicity，
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。
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
中图分类号 R457． 7; R379; R519
文献标识码 A
Current Status and Future Perspectives of Invasive Fungal Infections
epidemiology，risk factors and recent advances in the diagnosis and management of IFI in HSCT recipients．
Ke y words invasive fungal infections; hematopoietic stem cell transplantation; epidemiology; risk factors