恶性血液病患儿继发侵袭性肺部真菌感染4例的诊断和治疗

Diagnosis and treatment of 4 cases with hematological disease complicated with invasive pulmonary fungal infections

目的提高临床医师对儿童恶性血液病、肿瘤疾病患儿合并侵袭性肺部真菌感染(IPFI)尤其是侵袭性肺曲霉菌感染(IPA)的认识,早期及时地诊断及治疗提高患儿生存率。方法对本院在2007年1月至2008年6月收治的4例血液病患儿合并IPA的临床诊治过程及预后进行回顾性分析。结果 4例患儿均符合IPFI的诊断标准,1例为临床诊断,另3例为拟诊;4例患儿存在化疗后中性粒细胞减少>10 d,造血干细胞移植后移植物抗宿主病,长期应用激素等宿主因素,典型肺CT空洞改变;1例痰培养示咽曲霉菌生长的诊断依据,同时应用伏立康唑、米卡芬净等抗真菌药物治疗。4例患儿均死亡。结论儿童恶性血液病、恶性肿瘤合并IPA进展快、病原学诊断困难、预后差,早期诊断及治疗对挽救患儿生命至关重要。

Objective To make better understanding of pediatric malignant hematological/oncological diseases complicated with invasive pulmonary fungal infections （ IPFI）, especially with invasive pulmonary aspergitlosis （IPA） and to improve the survival of patients by early diagnosis and early treatment. Methods Retrospective analysis of clinical diagnosis, treatment and outcome in 4 hematological cases with IPA from Jan 1, 2007 to Jun 30, 2008 was performed. Results Four cases were all matched with the diagnostic standard of IPFI. Case 1 was clinical diagnosis and the other 3 were considered diagnosis. All of them had the host factors like neutropenia, GVHD or long-term use of glucocorticoid, typical pulmonary CT image and case 1 also got the evidence of aspergillus fuigatus in the culture of sputum. They were treated with voriconazole, micafungin and so on. But all of them ）finally died. Conclusion The pathogenic diagnosis was quite difficult for pediatric patients with IPA. And the clinical manifestation progressed rapidly with poor outcome. Early diagnosis and treatment was the key point for improving the survival rate for these patients.