血液病患者未达侵袭性真菌病诊断的临床研究  

Clinical study on diagnosis of uncertain invasive fungal diseases in patients with hemopathy

作　　者：林雪梅[1] 邓琦[1] 赵明峰[1] 李玉明[1] 

机构地区：[1]天津市第一中心医院血液科,天津300192

出　　处：《中华医院感染学杂志》2015年第16期3743-3745,共3页Chinese Journal of Nosocomiology

基　　金：天津市自然科学基金资助项目(13JCYBJC23400)

摘　　要：目的分析血液病患者不能明确诊断侵袭性真菌病（IFD）的临床资料,利于早期把握抗真菌治疗时机,降低病死率。方法收集2007年1月-2012年12月118例血液系统疾病且不能明确诊断IFD的患者临床资料,对其诊断、感染部位及各不同相关因素对发病率的影响进行分析,数据采用SPSS 17.0进行统计分析。结果 118例未达到IFD诊断患者分为不能诊断IFD但治疗有效88例和排除IFD诊断30例;真菌感染部位均以呼吸道为主,占64.77%;以血液恶性肿瘤化疗后粒细胞缺乏者发生率最高,10.24%;8∽14d粒细胞缺乏更为明显;发病年龄多为40∽60岁患者;所有上述病例应用抗真菌药物时均已同时应用≥3种抗菌药物,以碳青霉烯类为主,并均联合应用了万古霉素或利奈唑胺。结论临床可能对最终排除IFD诊断的患者应用了抗真菌治疗,但在患者重症感染而高度疑似IFD阶段,抗真菌治疗利大于弊,可挽救部分患者生命。OBJECTIVE To analyze the clinical data of hospitalized patients with blood diseases combined with unde‐fined invasive fungal disease （IFD） in our department from 2007 to 2012 so as to seize the opportunity to treat fun‐gal diseases in a early time and reduce the mortality rate .METHODS From Jan .2007 to Dec .2012 ,118 patients with hematologic diseases combined with undefined IFD were collected ,and their influence on the diagnosis ,the sites of infections and impacts of various related factors were analyzed .All data were statistically analyzed by SPSS 17 .0 software .RESULTS In this study ,118 patients failed to meet the diagnostic criteria for IFD were divided into two groups （88 patients who could not be diagnosed with IFD but the treatment was effective and 30 patients ex‐cluded from IFD） .Respiratory tracts were prone to be infected by fungi ,accounting for 64 .77% .Both of the two groups showed a high incidence of agranulocytosis in patients with hematological malignancies after chemotherapy , with the rate of 10 .24% ,especially after 8 to 14 days .The onset age was mostly 40∽60 years old .All the above patients were treated with antifungal drugs while using three or four antibiotics ,mainly carbapenems ,and they were all combined with vancomycin or linezolid .CONCLUSION In clinical practice ,antifungal therapy may have been used for patients ultimately excluded from IFD .However ,in patients with severe infection and highly sus‐pected with IFD ,antifungal therapy shows the advantages outweigh the disadvantages ,and can save lives of some patients .

关 键 词：血液病 侵袭性真菌病 流行病学 

分 类 号：R181.32[医药卫生—流行病学]