Timing Determination of Invasive Fungal Infection Prophylaxis According to Immune Function in HSCT Patients.
Timing Determination of Invasive Fungal Infection Prophylaxis According to Immune Function in HSCT Patients.
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根据HSCT患者免疫功能确定预防侵袭性真菌感染的时机
DOI：
10.3389/fmicb.2018.00370
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发表时间：
2018
影响因子：
5.2
通讯作者：
Xie Y
中科院分区：
文献类型：
--
作者：
Ma J;Hu Y;Wu M;Wang X;Xie Y
接受造血干细胞移植（HSCT）的患者在从中性粒细胞减少症中恢复后表现出免疫缺陷。目前的指南不建议在这些患者中进行真菌预防，除了HSCT中的III至IV级GVHD。因此，在免疫受损患者中开始和停止IFI预防的时机仍然是一项具有挑战性的奋进。我们回顾性分析了接受自体或异基因造血干细胞移植的患者，并通过检测IgG、伊加、IgM水平以及T、B、NK细胞数量来监测其中性粒细胞减少恢复后的免疫功能。我们发现IgG水平和NK细胞计数与IFI的发生率通过logistic回归（分别为p = 0.000 vs. 0.000）和条件logistic回归（p = 0.009 vs. p = 0.002）显示出显著差异。根据受试者工作特征曲线分别确定IgG < 7 mg/mL和NK细胞计数< 6.5 × 104/mL为IFI预防的起始点。平行试验增加了试验的灵敏度和特异性。因此，HSCT后患者开始预防的最佳时机可能是IgG < 7 mg/mL或NK细胞计数< 6.5 × 104/mL。未来的大规模前瞻性临床试验需要验证这些发现。自体或异基因造血干细胞移植后免疫功能低下的患者，通过免疫监测和适当的真菌预防，可能会受益于较低的真菌感染发生率。
Patients who receive a hematopoietic stem cell transplantation (HSCT) exhibit an immune defect after recovering from neutropenia. The current guidelines do not recommend fungal prophylaxis in these patients, except for grades III to IV GVHD in HSCT. Thus, the timing for the initiation and cessation of IFI prophylaxis in immune-compromised patients remains a challenging endeavor. We retrospectively analyzed patients who received auto or allo-HSCT and monitored their immune function after recovering from neutropenia by measuring the levels of IgG, IgA, IgM, as well as the number of T, B, NK cells. We found that the level of IgG and NK cell count exhibited a significant difference with the incidence of IFI by logistic regression (p = 0.000 vs. 0.000, respectively) and conditional logistic regression (p = 0.009 vs. p = 0.002). The initiation of IFI prophylaxis was determined to be IgG < 7 mg/mL and NK cell count < 6.5 × 104/mL by an receiver operating characteristic curve separately. Tests in parallel increased the test sensitivity and specificity. Thus, the optimal timing for initiating prophylaxis in patients after HSCT could be IgG < 7 mg/mL or NK cell count < 6.5 × 104/mL. Future large-scale prospective clinical trials are required to verify these findings. Patients who are immuno-compromised after auto or allo-HSCT may benefit from a lower fungi infection incidence with immune surveillance and proper fungal prophylaxis.
影响因子：
4.7
作者：
Lehrnbecher T;Schmidt S;Tramsen L;Klingebiel T
通讯作者：
Klingebiel T