白血病患儿并侵袭性真菌感染25例

Clinical Analysis of 25 Children with Acute Leukemia Combined with Invasive Fungal Infection

目的探讨白血病患儿并侵袭性真菌感染的易感因素、菌种、临床特点及治疗。方法对2002-2006年治疗的25例白血病并侵袭性真菌感染患儿的病前相关诱因、真菌种类、临床特点、治疗方案进行回顾性分析,并进行统计学处理。结果真菌种类包括念珠菌13例,其中白色念珠菌5例,热带念珠菌4例,近平滑念珠菌2例,光滑念珠菌、丝状真菌各1例;曲霉菌6例,其中烟曲霉菌3例,其他3例未能鉴定;镰刀菌1例。影像学诊断5例。感染部位以肺部为主17例(占68%);其次为真菌血症、皮肤、胸腹联合感染、口鼻腔、颅内。对其易感因素包括化疗药物使用时间、患者中性粒细胞绝对值、抗生素使用时间及种类、免疫功能进行统计学分析,均是引起真菌感染的易感因素。静脉滴注氟康唑治疗5例,死亡5例。静脉滴注两性霉素B治疗8例,死亡5例。单独应用伊曲康唑静脉滴注7例,死亡1例。伊曲康唑联合用药4例,死亡1例。脂质体两性霉素B治疗1例。总病死率48%。结论急性白血病患儿真菌感染的易感因素与化疗药物使用的累计时间、中性粒细胞绝对值、广谱抗生素联合使用时间和种类、免疫功能相关,菌种以念珠菌和曲霉菌最常见,感染部位以肺部最常见。早期经验性治疗可提高患者存活率,伊曲康唑有良好疗效。

Objective To explore the susceptible factor, the species of fungal, clinical character and treatment of invasive fungal infection in children with acute leukemia. Methods Twenty - five acute leukemiatic patients with invasive fungal infection from 2002 to 2006 were analyzed. Their susceptible factor, species, clinical manifestations and therapy were reviewed and statistic analyzed. Results The species of fungal：13 patients had candida infection（ candida albicans was 5 cases,candida tropicalis was 4 cases, candida parapsilosis was 2 cases, candida glabrata was 1 case, mold fungus was 1 case）. Six patients had aspergillus infection （ included one aspergillus fumigatus infection）. One patient had fusarium infection. Five patients had diagosised by X - ray and CT. The position of infection included lung, abdomen, nasal cavity, skin and encephalic. The susceptible factor excluded the days of chemotherapy, neutrophilic granulocyte count, the days of using broad spectrum antibiotics, the patient＇s immunity. The statistics analysis was used ,the result was positive. Five patients used diflucan and 5 cases died. Eight patients used amphotericin B, 5 cases died. Seyen patients used itraconazole alone, 1 case died. Four patients used itraconazole afflication other antifungal medicine, and 1 patient died. Amphotericin B packed in lipide treated 1 case. The total motality was 48%. Conclusions In patients with accute leukemia,the incidence of fungal infection is related closely to the days of chemotherapy, neurosurgery, the days and species of antibiotics, the patient＇s immunity. Candida and aspergillus are common. Lung is the mostly position of infection. The diagosed of fungal infection is difficult. The motality is high. hraconazole is better than other antifungal medicine.