血液病患者合并侵袭性真菌病12例临床分析

Hematologic disease complicated with invasive fungal diseases:report of 12 cases

目的探讨血液病患者合并侵袭性真菌病(IFD)的临床特点和治疗方法。方法回顾性分析我院血液科2008年2月—2010年2月收治的12例血液病合并IFD患者的临床表现、影像学特征及治疗情况。结果 12例患者中确诊(proven)1例、拟诊(probable)8例、疑似(possible)3例,分别给予氟康唑、两性霉素B脱氧胆酸盐、伊曲康唑口服胶囊或伏立康唑治疗,并同时予以粒细胞集落刺激因子(G-CSF)升高白细胞。治疗后确诊组1例死亡、拟诊组8例死亡3例、完全缓解2例、部分缓解3例;疑似组3例中死亡、完全缓解及部分缓解各1例,总病死率为41.7%。结论血液病合并IFD病死率高,在治疗IFD的同时,应用G-CSF对于血液病患者有中性粒细胞减少症或粒细胞缺乏症者,及早配合抗真菌药物应用具有一定的临床价值。

Objective To analyze the clinical characteristics and treatment of invasive fungal diseases （IFD） in patients with hematological disease. Methods The clinical data of 12 patients with hematological disease （from February 2008 to February 2010） were retrospectively analyzed. Results The 12 patients included 1 ＂proven＂, 8 ＂probable＂ and 3 ＂possible＂ cases of invasive fungal disease. The treatment included fluconazole, amphotericin B, itraconazole or voriconazole. Colony-stimulating factor （C-CSF） was also used to improve WBC. After treatment, the patient with proven IFD died. Of the 8 probable IFDs, 3 died, 2 showed complete response, and 3 showed partial response. Of the 3 patients with possible IFD, 1 CR, 1 PR and 1 died. The overall mortality was 41.7%. Conclusions Mortality rate was high in IFD patients with hematological disease. For the patients with neutropenia or agranulocytosis, early use of G-CSF and antifungal agents would be valuable.