重型再生障碍性贫血患者并发真菌感染的临床观察

Severe Type Aplastic Anemia with Fungal Infection: A Clinical Observation

目的了解重型再生障碍性贫血(SAA)患者并发真菌感染的临床特征。方法观察我院15年209例SAA患者并发真菌感染的患病率、菌谱、影响因素及预后。结果SAA患者并发真菌感染的患病率为18.18%,其中系统性真菌感染占47.37%;并发真菌感染与白细胞过低、院外长时间应用广谱抗生素有关,与年龄、T细胞亚群、免疫抑制治疗无关;浅部真菌感染以白色念珠菌为主,深部真菌感染以念珠菌及曲霉菌为主,曲霉菌感染有上升趋势;SAA患者并发真菌感染的病死率为34.21%,其中深部真菌感染占61.1%。结论真菌感染是SAA的常见并发症之一,以白色念珠菌及曲霉菌多见,病死率主要与白细胞低及长期应用广谱抗生素有关。

OBJECTIVE To study the clinical characteristics of severe type aplastic anemia （SAA） patients with fungal infection. METHODS The prevalence of fungal infection in 209 SAA cases residenting from 1990 to 2004 in Blood Disease Hospital,CAMS, the fungal spectrum, risk factors and prognosis were analyzed. RESULTS The prevalence of fungalinfection in SAA patients was 18. 18％, in which 47.37％ were invasive fungal infection. The risk factors of fungal infection were neutropenia, long-term usage of broad spectrum antibiotics. Patient＇ s age, T cell subtypes and immunosuppressive treatment were not found to have association with the fungal infection. The fungal infection of skin and mucous membrane was caused mainly by Candida albicans, and the invasive fungal infection was caused by Candida and Aspergillus. Aspergillus infection increased year by year. The total mortality of SAA patients with fungal infection was 34.21％, in which with invasive fungal infection was 61.1％. CONCLUSIONS Fungal infection is one of the common complications of SAA, usually caused by Candida and Aspergillus and associated with leukocytopenia and long-term usage of broad spectrum antibiotics.