儿童急性白血病合并侵袭性真菌病临床分析

Clinical Analysis of Childhood Acute Leukemia Complicated with Invasive Fungal Disease

目的:分析急性白血病(AL)患儿中合并侵袭性真菌感染(IFD)的临床特征及高危因素。方法:回顾性分析贵阳市儿童医院儿童血液科2017年1月-2019年12月确诊并规范治疗的75例AL患儿的临床资料。75例患儿发生48例次IFD,其中确诊4例,临床诊断19例,拟诊25例。对48例IFD的感染危险因素、临床特征、治疗及预后进行分析。结果:75例AL患儿在化疗中发生235例次感染,其中191例次急性淋巴细胞白血病感染者有38例次患儿发生IFD,发生率为19.9%;44例次急性非淋巴细胞白血病感染患儿中发生10例次IFD,发生率为22.7%;急性非淋巴细胞白血病与急性淋巴细胞白血病化疗中IFD发生率比较,差异无统计学意义(P>0.05)。48例次IFD感染部位最多的为呼吸道。48例次IFD中,G实验阳性率为35.4%,GM实验阳性率为8.3%,以念珠菌分离率最高。结论:IFD是AL治疗中主要并发症及死亡原因,导致IFD主要的感染因素有严重粒细胞缺乏、持续粒细胞缺乏,C反应蛋白升高。IFD的感染部位以肺部为主,胃肠道感染次之。IFD疗效的提升需做到早预防、早诊断、有效的抗真菌治疗及合理联用激素,可明显地改善患儿预后。

Objective:To analyze the clinical features and risk factors of invasive fungal infection(IFD)in children with acute leukemia(AL).Methods:The clinical data of 75 children with AL who were diagnosed and treated in the Department of Children's Hematology of Guiyang Children's Hospital from January 2017 to December 2019 were retrospectively analyzed.48 cases of IFD occurred in 75 children,among them,4 cases were confirmed,19 cases were clinically diagnosed,and 25 cases were proposed to be diagnosed.The infection risk factors,clinical features,treatment and prognosis of 48 cases of IFD were analyzed.Results:235 cases of infection occurred in 75 cases of AL children during chemotherapy,among which 191 cases of acute lymphoblastic leukemia infection occurred in 38 cases of children with IFD,the incidence rate was 19.9%.Ten cases of IFD occurred in 44 children with acute non-lymphocytic leukemia infection,and the incidence rate was 22.7%;there was no significant difference in the incidence of IFD between acute non-lymphocytic leukemia and acute lymphocytic leukemia in chemotherapy(P>0.05).Respiratory tract was the most frequently infected site in 48 cases of IFD.Among the 48 cases of IFD,the positive rate of G test was 35.4%,the positive rate of GM test was 8.3%,and the isolation rate of Candida was the highest.Conclusion:IFD is the main complication and cause of death in the treatment of AL.The main infectious factors leading to IFD are severe agranulocytosis,persistent agranulocytosis,and elevated C-reactive protein.The main site of IFD infection is the lungs,followed by gastrointestinal infections.The improvement of the efficacy of IFD requires early prevention,early diagnosis,effective antifungal treatment and reasonable combination of hormones,which can significantly improve the prognosis of children.