儿童真菌感染继发噬血细胞性淋巴组织细胞增生症3例分析  

Analysis of fungal infection complicated with hemophagocytic lymphohistiocytosis in three children

作　　者：许金云[1] 周晓姮 蒙惠华 杜立安 李鸣 罗建明[1] XU Jinyun;ZHOU Xiaoheng;MENG Huihua;DU Lian;LI Ming;LUO Jianming(Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China)

机构地区：[1]广西医科大学第一附属医院儿科,广西南宁530021

出　　处：《临床儿科杂志》2018年第5期339-343,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金资助项目(No.81160070)

摘　　要：目的提高对儿童真菌感染继发噬血细胞综合征的临床认识。方法总结3例确诊为真菌感染继发噬血细胞综合征患儿的相关资料。结果 3例患儿,男2例,女1例,年龄1岁7个月到3岁1个月,均以反复发热为主诉,2例伴咳嗽,1例伴呕吐,体检发现有肝脾及浅表淋巴结肿大。通过病原学检查确诊为真菌感染的时间均是入院后5天,在有效抗真菌治疗无效后进一步诊断为噬血细胞性淋巴组织细胞增生症。患儿血常规检查早期表现为白细胞计数升高,而血小板及血红蛋白不同程度降低。在抗真菌治疗基础上,2例按照HLH-2004方案进行化疗,1例仅增加地塞米松治疗,3例在治疗过程中均使用丙种球蛋白。最终3例患儿均好转出院。结论儿童真菌感染继发噬血细胞综合征临床少见,在抗真菌治疗基础上增加免疫抑制能改善患儿预后。Objective To improve clinically the recognition of fungal infection associated with hemophagocytic lymphohistiocytosis（HLH） in children. Methods Clinical data of 3 children with fungal infection complicated with HLH in our hospital was retrospectively analyzed. Results All the 3 cases complained of recurrent fever, 2 cases with cough and one case with vomiting. Hepatosplenomagaly and lymphadenectasis were found in the medical examination. The time of diagnosis of fungal infection through etiological examination was 5 days after admission. It was further diagnosed as hemophagocytic lymphohistiocytosis after failure of effective antifungal therapy. Routine blood test showed the counts of leukocytes were increased in early stage, while the number of platelets and hemoglobin decreased in different degrees. The recovery is not satisfactory using antifungal therapy alone, and 2 of them are gradually aggravated and treated with mechanical ventilation. On the basis of antifungal therapy, 2 cases were treated under HLH-2004 regimen, 1 received dexamethasone treatment. All the 3 cases received intravenous immune globulin, and showed improvement. Conclusions Fungal infection complicated with HLH in childhood is rare. The effect of simple antifungal therapy on the progression is limited. However, increasing immunosuppressive therapy based on effective antifungal therapy can improve the prognosis.

关 键 词：嗜血细胞性淋巴组织细胞增生症 真菌感染 治疗 儿童 

分 类 号：R725[医药卫生—儿科]