感染相关的免疫复原炎症综合征在血液细胞移植中
Mansi Chaturvedi1,2, Brian P Epling3, Luxin Pei3
1Critical Care Medicine and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
概括
免疫复合炎症综合征 (IRIS) 在血液细胞移植 (HCT) 接受者中未得到充分认可. 早期的抗微生物治疗和谨慎的免疫抑制管理是预防和治疗HCT后IRIS的关键.
科学领域:
- 免疫学 免疫学 免疫学
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
背景情况:
- 免疫复合炎症综合征 (IRIS) 是HIV患者开始ART的已知并发症.
- 血液细胞移植 (HCT) 接受者的IRIS数据有限.
- 本综述解决了HCT人口中关于IRIS的知识差距.
研究的目的:
- 审查有关IRIS在HCT接受者的文献.
- 描述IRIS在这个人群中的临床特征,触发因素和结果.
- 为了突显在HCT中的IRIS未得到充分认可的性质.
主要方法:
- 叙事文学评论. 叙事文学评论. 叙事文学评论. 叙事文学评论.
- 包括21项研究,包括53名HCT患者.
- 分析患者人口统计,IRIS类型 (BCG-IRIS,非BCG-IRIS),时间和管理.
主要成果:
- 大多数患者具有先天性免疫错误 (IEI) 并开发了BCG-IRIS.
- 非BCG-IRIS与Aspergillus和非结核性菌根菌相关.
- 到IRIS的中位时间为3个月,但可能发生在移植后的几年.
- 炎症生物标志物和病理学有助于诊断.
- 抗微生物治疗对于预防和治疗至关重要.
- 随着免疫抑制的减少,发生了回血.
- 移植与宿主疾病 (GVHD) 影响了三分之一的患者.
- 移植失败率为8%,死亡率为15%.
结论:
- 虹膜炎症 (IRIS) 是 HCT 接受者的未被认可的并发症.
- 将IRIS与感染区分开来至关重要.
- 适当的抗微生物治疗和免疫抑制管理至关重要.
- 需要进一步研究IRIS病原性,风险因素和HCT中的管理.
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