| 摘要: |
| 目的 分析异基因造血干细胞移植后发生结核感染的患者的临床特征、易感因素及转归，探讨其临床诊治经验。方法 收集7例在第二军医大学长海医院血液科行异基因造血干细胞移植后诊断为结核患者的发病时间、症状、实验室检查、影像、治疗及转归情况，总结其临床特点和规律。结果 第二军医大学长海医院血液科自2004年起共进行异基因造血干细胞移植481例，其中7例患者移植后并发结核感染，女性2例、男性5例，平均年龄为（31.3±9.6）岁，移植后结核的发病率为1.46%。7例患者中肺结核5例（血行播散型2例）、结核性胸膜炎1例、结核性脑膜炎2例、膀胱结核1例。临床表现多样化，包括发热、咳嗽、尿路刺激症状、头痛。有急/慢性移植物抗宿主病病史1例，慢性移植物抗宿主病病史2例。7例患者发病后结核菌素试验（PPD）、结核抗体检测均阴性，有3例外周血结核T细胞斑点检测（T-SPOT）阳性，其中1例肺泡灌洗液涂片抗酸染色阳性。1例行膀胱镜活检病理示炎性肉芽肿，1例行肺穿刺活检病理示肉芽肿性炎症伴凝固性坏死。影像学表现：肺部CT表现为斑片状影3例，粟粒状结节影2例，胸腔积液1例；合并真菌感染1例。经抗结核治疗后临床治愈6例，死亡1例，有效率85.7%。结论 异基因造血干细胞移植患者出现感染症状时需警惕结核的发生，早期进行筛查，避免误诊、漏诊。早期诊断并及时予以正规抗结核治疗可以取得较理想的疗效。 |
| 关键词: 异基因造血干细胞移植 移植物抗宿主病 结核 间充质干细胞 |
| DOI：10.16781/j.0258-879x.2016.08.1019 |
| 投稿时间：2015-10-21修订日期：2015-12-20 |
| 基金项目:上海市卫生系统优秀青年人才培养计划（XYQ2011007）. |
|
| Tuberculosis infection after allogeneic hematopoietic stem cell transplantation: an analysis of clinical characteristics |
| XIA Xin-xin,HU Xiao-xia,ZHANG Wei-ping,YANG Jian-min,WANG Jian-min* |
(Department of Hematology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the clinical characteristics, predisposing factors and prognosis of tuberculosis(TB) patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT), and to summarize the clinical treatment experience. Methods The information of 7 confirmed TB patients after allo-HSCT, including the onset time, symptoms,laboratory findings, imaging findings, treatment and prognosis, was collected, and their clinical characteristics and regulations were summarized. Results Seven of the 481 patients who received allo-HSCT were found to have TB, with an post-transplantation TB incidence rate of 1.46%. The seven patients included 2 females and 5 males, ranging 18-46 years and averaging (31.3±9.6) years old. Five patients had pulmonary tuberculosis (2 with hematogenous disseminated pulmonary tuberculosis), 1 had tuberculous pleurisy, 2 had tuberculous meningitis, and 1 had bladder tuberculosis. The clinical manifestations included fever, cough, urinary tract symptom, and headache. Three cases had history of chronic graft versus host disease(GVHD) while one of them experienced acute GVHD. PPD test and tuberculosis antibody test were negative in all the 7 patients: peripheral blood T-SPOT test was positive in 3 cases,with one having positive bronchoalveolar lavage fluid smear. Biopsy results showed granulomatous inflammation in 2 cases, with 1 accompanied by coagulative necrosis. Chest CT showed patched shadow in 3 cases, miliary nodule shadows in 2 and pleural effussion in one. Six patients were clinically cured after anti-tuberculosis treatment and one died, with an effective rate of 85.7%. Conclusion TB infection should be considered once the patients receiving allo-HSCT have infectious symptoms, and early screening should be done to avoid misdiagnosis and missed diagnosis. Early diagnosis and routine anti-TB treatment can yield good outcome. |
| Key words: allogeneic hematopoietic stem cell transplantation graft vs host disease tuberculosis mesenchymal stem cells |
