血液系统疾病并发侵袭性真菌感染临床分析

Clinical analysis of hematological diseases complicated with invasive fungal infections

目的探讨血液系统疾病并发侵袭性真菌感染(IFI)的临床特点及危险因素,以便于早期诊断、早期治疗。方法选取2006年1月-2012年10月威海市立医院血液科收治的48例血液系统疾病并发侵袭性真菌感染患者临床资料进行回顾性分析。结果 48例患者中共培养出真菌10株,以热带假丝酵母菌为主;48例IFI病例中肺部感染40例,CT影像学表现复杂多样,以双肺受累、结节影、团块状高密度影多见;中性粒细胞缺乏、广谱抗菌药物、糖皮质激素、血液系统疾病基础状态是IFI的危险因素;48例患者中治愈27例,显效10例,总有效率77.1%;死亡7例,病死率14.6%,抗真菌治疗药物安全性高,不良反应较少。结论血液系统疾病并发IFI以发热为主要表现,感染部位以肺部多见,高分辨率CT能检测到早期典型的病灶,IFI具有多种危险因素,及早发现并及时开始经验性抗真菌治疗,可提高疗效,降低病死率。

OBJECTIVE To analyze the clinical features and risk factors for hematological diseases complicated with invasive fungal infections so as to facilitate the early diagnosis and treatment. METHODS A retrospective analysis was performed for the clinical data of the 48 cases of hematological diseases complicated with invasive fungal infec- tions who were admitted to the department of hematology of Weihai Municipal Hospital from Jan. 2006 to Oct. 2012. RESULTS A total of 10 strains of fungi were cultured from 48 cases, and Candida tropicalis was the most. Among the 48 cases of invasive fungal infections, 40 of them had pulmonary infections, and the CT imaging find- ings were complicated and diversified, in which the double lung involvement, nodular shadows and crumb of high density shadow were common. The neutropenia, broad spectrum of antimicrobial agents, glucocorticoid, and un- derlying hematological system diseases were the risk factors for the invasive fungal infections. Among 48 cases, 27 patients were cured, 10 improved, and the total effective rate was 77.1%. Among the 48 cases, 7 patients died, accounting for 14.6%. Antifungal therapy had high safety, and the incidence of adverse reactions was low. CONCLUSION Fever is the predominant clinical manifestation of the hematological diseases patients complicated with invasive fungal infections, and pulmonary infection is the most common. High resolution CT can detect early typical lesions. There are many risk factors for the invasive fungal infections. Early diagnosis and empirical antifun- gal therapy can improve the clinical efficacy and reduce the mortality rate.