急性白血病患者发热伴肺部非特异影像学改变的治疗分析

Treatment of acute leukemia patients complicated with fever and change of pulmonary nonspecific imaging

目的探讨急性白血病患者化疗期间出现发热并伴有肺部非特异影像学改变的临床特征、影像学表现及治疗方法。方法回顾性分析2014年12月-2016年1月合并发热及肺部非特异影像学改变、并治疗有效29例急性白血病患者的特点及转归。结果 29例患者中,19例治愈,总治愈率65.5%;仅表现为单纯双肺弥漫/多发磨玻璃影的11例患者中,10例治愈,治愈率90.9%;磨玻璃影基础上合并斑片影等表现的18例患者中,9例治愈,治愈率为50.0%,两组差异无统计学意义;联合糖皮质激素治疗14例患者,10例治愈,治愈率为71.4%;未联合糖皮质激素治疗15例患者,9例治愈,治愈率为60.0%;两组差异无统计学意义;4例患者发热时中性粒细胞完全正常、肺部主要表现为单纯磨玻璃影、仅以抗细菌联合激素治疗,完全治愈,治愈率100.0%,剩余25例患者中,15例治愈,治愈率60.0%,两组差异有统计学意义(P<0.05)。结论化疗结束后,中性粒细胞已恢复正常,肺部CT主要表现为单纯磨玻璃影的患者,可不必加用抗真菌治疗;因此分析肺部CT非特异表现的具体形式,结合中性粒细胞数值等临床特征,可为临床经验治疗提供指导,减少过度治疗。

OBJECTIVE To explore the clinical characteristics,imaging findings,and treatment measures of the acute leukemia patients who had fever and were complicated with change of pulmonary nonspecific imaging during chemotherapy.METHODS From Dec 2014 to Jan 2016,the clinical characteristics and outcomes of 29 acute leukemia patients who were complicated with fever and change of pulmonary nonspecific imaging that were effective for treatment were retrospectively analyzed.RESULTS Of the 29 patients,19 were cured,with the total cure rate 65.5%.Among the 11 patients whose pulmonary imaging was manifested with single lungs diffused or multiple ground glass shadow,10 were cured,with the cure rate 90.9%.Among the 18 patients whose pulmonary imaging manifestations were ground glass shadow complicated with patchy shadow,9 were cured,with the cure rate 50.0%,and there was no significant difference between the two groups.Among the 14 patients who were given combined glucocorticoid therapy,10 were cured,with the cure rate 71.4%.Among the 15 patients who were not given combined glucocorticoid therapy,9 were cured,with the cure rate 60.0%;there was no significant difference between the two groups.The neutrophils level of 4 patients with fever was absolutely normal,the single ground glass shadow was the major pulmonary manifestation,and they were completely cured after antibacterial treatment combined with hormonotherapy,with the cure rate 100.0%;among the rest of 25 patients,15 were cured,with the cure rate 60.0%,and there was significant difference between the two groups （P〈0.05）.CONCLUSION The neutrophils level recovers to normal after chemotherapy;the single ground glass shadow is the major pulmonary CT manifestation,and it is not necessary to add the antifungal therapy.It is an effective way to analyze the specific forms of the nonspecific pulmonary CT manifestations and combine with the clinical characteristics such as the neutrophils counts so as to provide guidance for clinical empirical therapy and reduce excessive treatment.