白血病患者化疗后肺部侵袭性真菌感染早期治疗时机探讨

Opportunity of early empirical antifungal treatment for pulmonary invasive fungal infections after chemotherapy of leukemia

目的探讨急性髓细胞白血病(AML)患者化疗后肺部侵袭性真菌感染(IFI)早期经验性抗真菌治疗的时机,以探讨其临床价值。方法收集2013年3月-2014年3月于医院接受治疗的急性髓细胞白血病患者化疗后肺部侵袭性真菌感染体温<38.5℃25例作为A组,给予亚胺培南治疗,患者发热改善后给予降阶梯式抗菌药物治疗;体温≥38.5℃20例作为B组,给予亚胺培南治疗,肺部CT提示肺部炎性病变无变化甚至加重,立即给予患者伏立康唑治疗;采用SPSS17.0进行数据统计分析。结果肺部IFI的发生率为72.00%;治疗抗感染有效率A组为20.00%、B组为85.00%,两组比较差异有统计学意义(P<0.05)。结论 AML患者化疗后出现肺部侵袭性真菌感染,其发病率较高,临床治疗应考虑早期给予经验性抗真菌药物,可有效改善患者临床症状。

OBJECTIVE To study the opportunity of early empirical antifungal treatment for pulmonary invasive fungal infections （IFI） after chemotherapy of acute myelogenous leukemia （AML） ,so as to investigate the clinical value .METHODS A total of 25 cases of patients （temperature 〈38 .5 ℃） who were infected by pulmonary inva‐sive fungal after chemotherapy of acute myeloid leukemia were collected from Mar .2013 to Mar .2014 in our hos‐pital .They were treated as group A and were given imipenem .If the patients fever improved ,gave them stepped down antibiotic treatment .A total of 20 patients whose temperature ≥ 38 .5 ℃ were served as group B and were given imipenem too .If CT scan showed no change even worse in pulmonary inflammatory lesions ,the patient seww given voriconazole immediately .SPSS17 .0 was adopted for a statistical analysis .RESULTS The incidence of lung IFI was 72% .The anti‐infection rate of imipenem combined with stepped down antibiotics （group A） was 20% ,the anti‐infection rate of voriconazole antifungal therapy （group B） was 85 .00% ,and there was significant difference （P〈0 .05） .CONCLUSION AML patients have a high incidence in getting pulmonary invasive fungal in‐fection after chemotherapy ,early empirical antifungal drugs should be considered for clinical treatment ,which can effectively improve the clinical symptoms of patients .