造血干细胞移植治疗恶性血液病合并播散性镰刀菌病4例临床分析并文献复习

Clinical analysis of 4 cases of disseminated fusariosis with hematological malignancies treated by hematopoietic stem cell transplantation and literature review

目的提高对造血干细胞移植患者合并镰刀菌感染,尤其是播散性镰刀菌病的认识,以做到早期诊断、及时治疗,从而改善其预后。方法对本院从2015年4月至2020年9月诊治的4例造血干细胞移植患者合并播散性镰刀菌病的诊断、治疗及预后进行回顾性分析。结果4例患者均为确诊病例,均发生于造血干细胞植活前或粒缺期,给予两性霉素B脂质体/两性霉素B联合伏立康唑抗真菌治疗。3例患者的播散性镰刀菌病得到控制(其中1例死于铜绿假单胞菌败血症),1例抗真菌治疗后无效死亡。结论造血干细胞移植后播散性镰刀菌病预后差,死亡率高,早期给予有效抗真菌治疗及快速免疫重建是改善其生存率的有效手段。

Objective To improve the understanding of fusariosis,especially disseminated fusariosis,in patients with hematopoietic stem cell transplantation,so as to achieve early diagnosis and timely treatment,and improve the prognosis.Methods To retrospectively analyze the diagnosis,treatment and prognosis of 4 cases of hematopoietic stem cell transplant patients with disseminated fusariosis treated in our hospital,from April 2015 to September 2020.Results All the 4 patients were confirmed cases that occurred before hematopoietic stem cell implantation or neutrophilic phase,and received amphotericin B liposome combined with voriconazole.Disseminated fusariosis was controlled in 3 patients,and one patient died after treatment.Conclusion Disseminated fusariosis after hematopoietic stem cell transplantation had poor prognosis and high mortality.Effective antifungal therapy and rapid immune reconstruction in early stage were effective means to improve the survival.