Tuberculosis after hematopoietic stem cell transplantation:: incidence, clinical characteristics and outcome
Tuberculosis after hematopoietic stem cell transplantation:: incidence, clinical characteristics and outcome
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DOI：
10.1038/sj.bmt.1702506
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发表时间：
2000-08-01
影响因子：
4.8
通讯作者：
Carreras, E
中科院分区：
文献类型：
--
作者：
de la Cámara, R;Martino, R;Carreras, E
一项关于造血干细胞移植（SCT）后结核病的全国调查研究了其发病率、临床表现和结果。在8013例患者中发现20例确诊病例（5147例自体移植8例，2866例同种异体移植12例），全组估计发病率为每10(5)例/年（95% CI）为101例（56.5-145），自体移植71.1例（21.8-120），同种异体移植135.6例（58.9-212）。与一般人群相比，同种异体移植后结核病发生率更高（RR 2.95），而自体SCT后结核病发生率不高。SCT后结核病是一种晚期感染（移植后中位324天），主要影响肺部（80%的病例），似乎对治疗反应良好，但在同种异体移植受体中死亡率很高（25%）。它也可能使移植后的管理复杂化，因为抗结核药物经常降低血清环孢素水平，导致GVHD加重，移植物抗宿主病，皮质类固醇治疗和全身照射似乎与异体受体的结核病有关。自体移植中无明显因素与结核相关。最后，我们发现，由于将结核频率直接转化为发病率，已发表的关于固体和SCT后结核的文献高估了其发病率。
A national survey of tuberculosis after hematopoietic stem cell transplant (SCT) was undertaken to study incidence, clinical presentation and outcome. Twenty confirmed cases were found among 8013 patients (eight in 5147 autologous and 12 in 2866 allogeneic SCT), The estimated incidence in cases/10(5) patients/year (95% CI) was 101 (56.5-145) for the whole group, 71.1 (21.8-120) in autologous and 135.6 (58.9-212) in allogeneic transplants. Compared with the general population, tuberculosis was more frequent after allogeneic (RR 2.95) but not after autologous SCT, Tuberculosis after SCT is a late infection (median 324 days post transplant), predominately affects the lungs (80% of the cases), appears to respond well to treatment but has a high mortality (25%) in allogeneic recipients. It can also complicate the post-transplant management as antituberculosis drugs frequently decrease the serum levels of cyclosporine causing an aggravation of GVHD, Graft-versus-host disease, corticosteroid treatment and total body irradiation appear to be associated with tuberculosis in allogeneic recipients. No obvious factors were associated with tuberculosis in autologous transplants. Finally, we found that the published literature on tuberculosis after solid and SCT has overestimated its incidence due to the direct translation of tuberculosis frequency into incidence.