血液病患者真菌血症临床特征回顾性研究  

Retrospective study on clinical characteristics of hematologic malignancies patients complicated with fungemia

作　　者：马永超[1] 张晓艳[1] 陈传欣[1] 仇红霞[1] 徐卫[1] 钱思轩[1] 吴汉新[1] 陆化[1] 李建勇[1] 

机构地区：[1]南京医科大学第一附属医院血液科,江苏南京210029

出　　处：《中华医院感染学杂志》2016年第9期1987-1989,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81070456;81270652);卫生公益性行业科研专项基金资助项目(201202017);江苏高校优势学科建设工程基金资助项目(JX10231801)

摘　　要：目的通过分析血液病患者发生真菌血症的临床特征,进一步探讨其预防及诊治措施。方法对2008年1月-2014年6月医院16例血液病合并真菌血症患者的菌种分布、临床表现、诊疗措施、疗效和预后进行回顾性分析。结果 16例血液病合并真菌血症患者根据多国癌症支持治疗协会(MASCC)评分,高危11例、低危5例;根据血液病患者侵袭性真菌感染危险度分层所有患者均属于高危组;血培养结果检出热带假丝酵母菌11株占68.8%,白色假丝酵母菌3株占18.8%,黏性毛孢子菌1株占6.2%,镰刀菌1株占6.2%;突破性真菌血症6例占37.50%;治疗方案为单药治疗10例,联合用药6例;治疗有效11例占68.80%,均为完全缓解,死亡5例,其中2例治疗无效,3例放弃治疗。结论热带假丝酵母菌血症在真菌血症患者中发病率最高,血液病患者侵袭性真菌感染危险度分层方法更适合评估血液病患者发生真菌感染的危险性。OBJECTIVE To investigate the clinical characteristics of hematologic malignancies patients complicated with fungemia and further explore the measures for prevention and treatment.METHODS A total of 16 hematologic malignancies patients complicated with fungemia who were treated in the hospital from Jan 2008 to Jun 2014 were enrolled in the study.The distribution of pathogens,clinical manifestations,diagnosis measures,therapeutic effects,and prognosis were retrospectively analyzed.RESULTS According to the multinational association for cancer support therapy,11 of 16patients were at high risk,5at low risk.According to the risk stratification scheme for invasive fungal infections,all of the patients were at high risk.The results of blood culture showed that there were 11（68.8%）strains of Candida tropicalis,3（18.8%）strains of Candida albicans,1（6.2%）strain of Trichosporon mucoides,and1（6.2%）strain of Fusarium.There were 6（37.50%）patients with breakthrough fungemia.Totally 10 patients were treated with single-drug regimen,and 6patients were treated with combined drug regimen;totally 11（68.80%）patients were effective for the treatment and completely recovered,5cases died,2cases were ineffective,and 3cases abandoned the treatment.CONCLUSION The morbidity rate of C.neoformans bacteremia is the highest among the patients with fungemia.The risk stratification scheme for invasive fungal infections is more suitable for assessment of the risk of fungal infections in the patients with hematologic malignancies.

关 键 词：血液病 真菌血症 热带假丝酵母菌 血培养 

分 类 号：R552[医药卫生—血液循环系统疾病]