急性白血病大剂量化疗肺部真菌感染研究分析

The Study of Lung Fungal Infection of Acute Leukemia Patients treated by High Dose Chemotherapy

目的比较白血病经大剂量化疗和常规剂量化疗两种缓解后治疗方案的肺部真菌感染率。方法选取经标准方案诱导达缓解的AML患者42例,ALL患者37例,其中AML患者经大剂量Ara-C进行缓解后治疗方案者23例,经标准DA或HA加或不加Vp-16作为缓解后治疗方案者19例,ALL患者经大剂量MTX或hyper-CVAD进行缓解治疗者21例,以经典VCDPA联合或不加L-asp作为缓解后治疗患者16例。结果经大剂量化疗的23例AML患者有11例感染真菌,经常规剂量化疗的19例AML患者有3例真菌感染;经大剂量化疗的21例ALL患者有10例感染真菌,经常规剂量化疗的16例ALL患者有5例真菌感染。AL患者经大剂量化疗真菌感染率明显高于常规剂量化疗患者,P<0.05,差异显著,AML患者与ALL患者化疗后真菌感染率差异不显著,P>0.05。结论AL患者经大剂量化疗真菌感染率明显高于常规剂量化疗患者。应加强抗真菌预防性或验性治疗。

Objective To compare the lung fungal infection rate between the acute leukemia patients with the high dose chemotherapy and regular ones after the remission.Method 42 cases of AML patients and 37 ALL with remission were chosen after standard chemotherapy.23 of AML patients were treated with high dose cytarabine chemotherapy and 19 of them by regular DA or HA regimen with or without etoposide.21 cases of ALL patients were treated with high dose methotrexate and hyper-CVAD regimen and 16 of them with typical VCDP regimen with and without L-asparaginase.Result 11 of 23 cases of AML patients treated by high dose chemotherapy were diagnosed of lung fungal infection,only 3 of 19 cases of AML patients treated by standard dose chemotherapy were diagnosed;but 10 of 21 cases of ALL patients treated by high dose chemotherapy were diagnosed of lung fungal infection,only 5 of 16 cases of ALL patients treated by standard dose chemotherapy were diagnosed.The acute leukemia patients treated by high dose chemotherapy got significantly higher percentage of lung fungal infection than ones treated by standard dose,P〈0.05.But the lung fungal infection rate have no significantly difference be-tween AML and ALL patients,P〉0.05.Conclusion The acute leukemia patients treated by high dose chemotherapy got significantly higher percentage of lung fungal infection than ones treated by standard dose.The prophylactic and experienced antifunfal therapy should be strengthened.