23例血液病患者侵袭性真菌感染临床分析

Clinical analysis of invasive fungal infection in 23 patients with hematological diseases

目的:分析23例血液病患者并发侵袭性真菌感染(IFI)的宿主因素、临床特点、抗真菌治疗及疗效。方法:回顾性分析23例侵袭性真菌感染的临床资料。结果:宿主免疫功能低下是导致IFI的重要因素之一。IFI中肺部感染最多见,占82.6%(19/23例)。发热、呼吸困难、低氧血症、肺部影像学变化是IFI最常见的临床特征,也是临床观察及判断疗效的重要指标。所有IFI患者发热占87.0%(20/23例),19例肺部真菌感染病例几乎均伴有发热、呼吸困难,并发低氧血症占84.2%(16/19例)。肺部真菌感染患者均出现肺部影像学改变,其中典型的"光晕征"或"新月征"占63.2%(12/19例)。上述临床特点不具备特征性,尽快获得病原学证据比较困难。目前综合上述临床特点、按照中国IFI诊断指南是临床诊断IFI的主要方法。本研究中抗真菌治疗总有效率(痊愈加显效)66.7%,抗真菌治疗药物安全性良好。结论:免疫功能状态与IFI发生及治疗疗效相关,早期诊断IFI困难。对真菌感染进行临床分层诊治是血液病发生IFI的重要诊治模式。

Objective：Twenty-three invasive fungal infection（IFI） patients with hematological diseases were analyzed on host factors,radiological features,clinical characteristics and therapeutic efficacies.Method：Retrospective analysis was performed on the clinical data of 23 IFI patients with hematological diseases.Result：Immunocompromise status of hosts played a key role in developing IFI in patients with hematological diseases.Pulmonary IFI,as one of the most common types,accounted for 82.6% of all IFI patients.The common clinical manifestations including fever,anorexia,hypoxia and abnormal radiological changes in lung were important indicators for clinical observations and evaluation of therapeutic efficacy.Patients with fever accounted for 87.0% of all IFI patients,and hypoxia was 84.2% in 19 pulmonary IFI patients which were all complicated with fever and anorexia.Pulmonary IFI patients all presented abnormal radiological characters.Typical halo sign and/or air crescent sign in lung CT image accounted for 63.2%.However all the above clinical manifestations were non-specific,and it was difficult to detect microorganisms in early stage.The primary diagnosis of IFI was based on the combination of clinical manifestations according to diagnostic criteria and therapeutic principle of IFI in hematological diseases or malignant tumors（2007） made in China.Total efficacy rate was 66.7% in IFI patients with anti-fungus management which had relatively good safety.Conclusion：Immunocompromised status of hosts is associated with IFI development and therapeutic efficacy.It is difficult to diagnose IFI in early stage.Stratified diagnosis and therapy is an important pattern for IFI patients with hematological diseases.