儿童侵袭性肺曲霉菌病16例临床分析

Clinical analysis of 16 cases of invasive pulmonary aspergillosis in children

目的探讨儿童侵袭性肺曲霉菌病（IPA）的诊断及治疗。方法回顾性分析2006年1月至2014年6月广西医科大学第一附属医院确诊或临床诊断IPA的16例患儿临床资料。四格表确切概率法进行组间比较。结果16例患儿中男11例，女5例，确诊1例，临床诊断15例。宿主高危因素为：长时间使用多种广谱抗菌药物16例，中性粒细胞减少症9例，有创机械通气3例，原发性免疫缺陷病2例，长期使用糖皮质激素2例，麻疹2例，先天性肺发育不良1例。16例患儿均有发热、咳嗽、咳痰（痰响）（0／7和1／7）。诊断时，中性粒细胞减少症组“晕轮征”（5／9）、胸膜下楔形实变影（7／9）高于非中性粒细胞减少症组（0／7和1／7）（P〈0．05）；抗曲霉菌治疗15d-1个月后，空洞、“空气新月征”阳性率高于诊断时（P〈0．05）。血清半乳甘露糖聚糖抗原检测阳性率高于痰培养及血清G实验（P〈0．05）。13例首选伏立康唑治疗，7例有效。结论中性粒细胞减少症是儿童IPA常见宿主高危因素。胸膜下楔形实变影、“晕轮征”及“空气新月征”对诊断有提示意义，前两者在有中性粒细胞减少症患儿早期更多见。血清GM实验有较高的诊断价值。大部分IPA患儿伏立康唑治疗有效。

Objective To investigate the diagnosis and treatment of invasive pulmonary aspergillosis （IPA） in children. Method The clinical data of 16 cases of proven or probable IPA who had been in our Hospital from January 2006 to June 2014 were retrospectively analyzed. Result Among the 16 patients, 11 were males and 5 were females. One child had proven IPA and 15 children had probable IPA. Host risk included long duration use of multiple broad-spectrum antibiotics in 16 cases, neutropenia in 9 cases, invasive mechanical ventilation in 3 cases, primary immunodeficiency disease in 2 cases, long-term use of glucocorticoids in 2 cases, measles in 2 cases, and congenital pulmonary hypoplasia in 1 case. Fever, cough and expectoration were present in all the children with IPA. At the time of diagnosis, the halo sign and subpleural wedge consolidation shadows were more common in neutropenia group （5/9,7/9） than those in non-neutropenia group（O/7,1/7 ） （P 〈 O. 05 ）. The cavities and ＂air-crescent sign＂ were more common after 15 days to 1 month when the children had been treated with anti-aspergillosis drugs than that at the onset of diagnosis of IPA （ P 〈 0. 05 ）. The positive rate of serum galactomannan （GM） test was higher than that of sputum culture and serum G test （ P 〈 0.05 ）. Thirteen children received voriconazole, in 7 of the children the treatment was effective. Conclusion Neutropenia were the common host risk factors in children with IPA. Subpleural wedge consolidation shadows, the halo sign and the ＂ air-crescent＂ sign were highly suggestive of the diagnosis of IPA in children. Subpleural wedge consolidation shadows and the halo sign were more common in neutropenia group than in non-neutropenia group in the early stage of the course. Serum GM test played an important role in the diagnosis of IPA in children. Voriconazole was effective in majority of the children with IPA.