血液病患者合并侵袭性真菌病的临床分析

Clinical analysis of invasive fungal diseases in patients with hematopathy

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。方法回顾性分析医院血液科2008年2月-2011年2月收治的42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 42例患者中确诊8例、拟诊28例、疑似6例,分别给予氟康唑、两性霉菌B脱氧胆酸盐、伊曲康唑或伏立康唑治疗,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8例病死4例、完全缓解1例、部分缓解3例;拟诊组28例病死11例、完全缓解7例、部分缓解10例;疑似组6例中病死、完全缓解及部分缓解各2例,总病死率为40.48%。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 treatments of invasive fungal diseases（IFD） in patients with hematological disease.METHODS The clinical data of 42 patients with hematological disease from Feb 2008 to Feb 2011 were retrospectively analyzed.RESULTS The patients comprised 8 cases of ＂proven＂,28 cases of ＂probable＂ cases of ＂possible＂.The treatments included fluconazole,amphotericin B,itraconazole and voriconazole,and colony-stimulating factor（G-CSF） were easy to increase WBC.Out of 8 proven patients,four patients died while one was complete response,three were partial responses.In 28 probable,eleven died while seven was complete response,ten were partial responses.And six patients of possible diagnosis got 2 CR,PR and died,respectively.The overall mortality was 40.48%.CONCLUSION Mortality rate is high in patients diagnosed of IFD with hematological disease.Among the patients with neutropenia or agranulocytosis,the early use of G-CSF with antifungal agents be valuable.