恶性血液病患儿合并深部真菌感染的临床分析  

A clinical analysis of the deep fungal infection in childhood malignant hemopathy

作　　者：周敦华[1] 黄绍良[1] 方建培[1] 钟凤仪[1] 薛红漫[1] 陈纯[1] 

机构地区：[1]中山大学第二附属医院儿科,广州510120

出　　处：《中华儿科杂志》2002年第10期582-584,共3页Chinese Journal of Pediatrics

摘　　要：目的　探讨恶性血液病患儿骨髓抑制期发生深部真菌感染的诊断和治疗。方法　近10年来诊断为恶性血液病合并深部真菌感染的患儿 15例 ,行血培养、骨髓培养、局部组织检查以了解病原菌 ,并予以抗真菌治疗。结果　从发热到确诊的时间平均为 9 7d ;15例中 13例口腔见特异性真菌感染病灶 ,10例真菌病原学检查阳性 ,9例为念珠菌 ,1例为曲霉菌感染 ;9例氟康唑治疗无效者改用脂质体二性霉素B(L AMB)后 5例治愈 ;死于真菌感染的患儿共 5例。结论　深部真菌感染的早期诊断及治疗困难 ,死亡率高 ;口腔特异性病灶是真菌感染的早期临床表现 ;L AMB是治疗深部真菌感染的首选药物 。Objective Along with the intensive radiotherapy, chemotherapy and the use of broad spectrum antibiotics, the probability of deep fungal infections (DFI) was increased in childhood malignant hemopathy during the hypoplasia of bone marrow However, the early diagnosis and the treatment of DFI have been difficult Hence, the present study was undertaken to analyze the experience of early diagnosis and the treatment of DFI Methods A total of 15 patients had been treated in the hospital for nearly 10 years, of whom 6 patients suffered from acute lymphoblastic leukemia (ALL); 3 acute non lymphoblastic leukemia (ANLL); 1 malignant lymphoma; 3 severe aplastic anemia and 1 just after hematopoietic stem cells transplantation When the diagnosis of DFI was made, the fungal culture from blood and bone marrow or from other tissues were performed and fluconazole or liposomal amphotericin B (L AMB) was used for the treatment The effect and the side effect of the drugs were observed Results From January 1990 to October 1998, there were only 4 patients developing DFI amongst all of the cases of malignant hemopathy (9 5%), while from September 1998 to October 2001, there were 11 patients having DFI amongst all of the cases of malignant hemopathy (16 4%) The main clinical manifestations consisted of fever, toxicemia, stomatitis,cough or dyspnea, abdominal pain, diarrhea, vomiting, hemorrhage of digestive tract and hepatosplenomegaly The average duration of fever before the confirmation of diagnosis was 9 7 days Fungal infections in oral cavities were found in 13 cases Three cases were confirmed by blood culture, 1 case by bone marrow culture, and 5 cases by the culture of secretion from oral cavity or from perianal scurf Aspergillus was found in 1 case by the biopsy from mucous membrane of mouth Five out of 9 patients insensitive to fluconazole were cured by L AMB Acute renal failure was found only in 1 case treated by L AMB plus cyclosporin Five cases died of DFI Conclusion The early dia

关 键 词：儿童 合并症 恶性血液病 深部真菌感染 临床分析 两性霉素B 

分 类 号：R733[医药卫生—肿瘤] R519[医药卫生—临床医学]