肾脏科患儿合并侵袭性真菌感染临床分析  

Clinical analysis of invasive fungal infection in children of nephrology department

作　　者：樊剑锋[1] 段晓岷[2] 刘小荣[1] 周楠[1] 孟繁英[1] 孟群[1] 陈植[1] 

机构地区：[1]首都医科大学附属北京儿童医院肾脏科,100045 [2]首都医科大学附属北京儿童医院影像科,100045

出　　处：《中华实用儿科临床杂志》2015年第5期359-361,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都临床应用研究特色基金（Z121107001012052）

摘　　要：目的 分析肾脏科住院患儿合并侵袭性真菌感染的临床特点。方法 回顾性分析 1999年至2014年27例肾脏科住院患儿并发侵袭性真菌感染的临床资料。结果 9例为泌尿系念珠菌感染，8例为肺孢子菌病肺炎，4例侵袭性肺曲霉菌病和1例侵袭性泌尿系曲霉菌感染，2例新型隐球菌脑膜炎，2例为肺念珠菌病，1例为肺丝状真菌感染。均存在基础病变，其中10例为原发性肾病综合征，7例继发性肾病综合征，6例伴有泌尿系统发育畸形，4例为〈32周早产儿和低出生体质量儿。均使用过抗生素。17例患儿有接受糖皮质激素和/或免疫抑制剂史。16例有侵入性操作史。27例均有发热症状，14例出现喘憋，7例进行性呼吸困难和呼吸衰竭，5例合并多脏器衰竭。8例肺孢子菌病患儿胸部CT示弥散磨玻璃影伴“马赛克”征；4例肺曲霉菌病患儿见肺多发结节影、易形成空洞。2例肺念珠菌病患儿病灶边缘模糊、浓淡不均，呈小斑片影，位于双肺中下野、不累及肺尖。23例接受足疗程抗真菌治疗，经治疗后16例痊愈，3例好转，4例死亡。4例放弃治疗。结论 长期使用激素和免疫抑制剂、不恰当使用抗生素、低出生体质量早产儿、泌尿系统发育畸形、侵入性操作等是侵袭性真菌感染的易感因素。不同的真菌感染影像学有不同特点，尽管不具备诊断特异性，但其相对特征性表现可为早期诊断提供一定的线索。Objective To explore the clinical features of invasive fungal infection in 27 children treated at nephrology department between 1999 and 2014. Methods Twenty - seven cases of invasive fungal infection at nephro- logy department were analyzed retrospectively. Results Candida urinary infection was found in 9 cases, pnenmocystis carinii pneumonia were found in 8 cases,invasive pulmonary aspergillosis and urinary aspergillosis found in 4 cases and 1 case respectively, cryptoeoccus neoformans meningitis and pulmonary candidiasis found respectively in 2 cases, and pulmonary filamentous fungal disease was found in 1 case. These 27 cases showed different features of illness ： 10 primary nephrotic syndrome ,7 secondary nephrotic syndrome ,6 malformation of urinary development and 4 preterm birth 〈 32 weeks gestational age with low birth weight. All of the cases had the history of taking antibiotics. Seventeen cases of them had used corticosteroid and cytotoxic drugs in a long - term. Sixteen cases had experienced invasive procedures. All children had fever in varying degrees, 14 cases showed gasp ,7 cases had progressive hypoxia and respiratory failure, and 5 cases developed into multiple organs failure. Chest computed tomographic （ CT ） imaging data showed diffuse ground -glass opacity with mosaic sign of pneumocystis earinii pneumonia（ 8 cases）. The features of pulmonary asper- gillosis included multiple nodules and cavity in bilateral lungs （4 cases）. The radiologie findings showed patching lesions with indistinct edge and uncertaincd density of bilateral middle - lower lung fields with pulmonary candidiasis （ 2 cases）. Full dose of antifungal drug was given to 23 cases of them, 16 cases recovered completely,3 got better,4 cases died. Four cases gave up full dose antifungal therapy. Conclusions Long - term use of corticosteroid and cytotoxic drugs, use of broad - spectrum antibiotics, invasive therapies, such as indwelling centralvenous catheters, endotracheal intubation with mechanical ventilation,

关 键 词：肾脏科 侵袭性真菌感染 临床分析 儿童 

分 类 号：R726.9[医药卫生—儿科]