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[Current Approaches to Diagnosis and Treatment of Invasive Fungal Infection in HSCT Recipients.]
造血干细胞移植受者侵袭性真菌感染的现代诊疗方法

出处: Zhongguo Shi Yan Xue Ye Xue Za Zhi   2009   Dec   17 (6) :1619-23

作者:Shao Q;Shen DX

PMID:20030960

Invasive fungal infections (IFI) are a kind of the most severe complications after hematopoietic stem cell transplantation (HSCT), Candida and Aspergillus are common causes. Because of immunosuppressive therapy, ablative conditioning regimen, acute or chronic graft-versus-host disease, long-term treatment of broad-spectrum antibiotics and cytomegalovirus infection, IFI has increased in the past few years. Invasive mould infection is a major cause of morbidity and mortality in HSCT recipients. Methods for early diagnosis of IFI include clinical and laboratory examinations, as well as characteristic radiography. Voriconazole is the first-line antifungal agent for prevention of IFI. Combination therapy of two antifungal compounds such as azoles or amphotericin B with echinocandins have shown a good effectiveness and may be a promising future strategy for antifungal treatment. In this review, the early diagnosis and treatment of IFI in HSCT recipients are summarized. As for early diagnosis of IFI, the laboratory diagnosis techniques such as GM test, G test and PCR techniques are discussed. As for prophylaxis and freatment of IFI, the prophylaxis treatemnt, empirical treatment, preemptive treatment, targeted treatment, combined treatment and immunologic treatment are discussed.

侵袭性真菌感染(IFI)是一种十分严重的造血干细胞移植(HSCT)并发症,以念珠菌属和曲霉菌属感染最常见。由于免疫抑制治疗、去髓性预处理、急慢性移植物抗宿主病、广谱抗生素的长期使用和巨细胞病毒感染,IFI的发病率在逐渐增加。侵袭性霉菌感染是HSCT受者发病和死亡的主要原因。IFI的早期诊断方法包括临床和实验室检查,以及特征性的放射检查。伏立康唑是预防IFI的一线抗真菌制剂。诸如三唑类或两性霉素B+棘球白素类药物的联合治疗已经显示出很好的疗效,是充满希望的抗真菌治疗策略。本文主要综述了HSCT受者出现IFI的早期诊疗方法。针对IFI的早期诊断主要讨论了GM检测、G检测和PCR技术等实验室诊断方法,针对IFI的预防和治疗主要讨论了预防性治疗、经验性治疗、预先治疗、靶向治疗、联合治疗和免疫治疗等方法。