儿童肺部侵袭性真菌感染93例临床回顾性分析  

Retrospective analysis of 93 cases of invasive fungal infection in children′s lung

作　　者：辜淑君 林育能[1] 吴上志[1] 黄展航 陈晓雯[1] 苏丹虹[2] 邓宇[3] 顾莹莹[4] 陈德晖[1] Gu Shujun;Lin Yuneng;Wu Shangzhi;Huang Zhanhang;Chen Xiaowen;Su Danhong;Deng Yu;Gu Yingying;Chen Dehui(Department of Pediatrics,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Clinical Laboratory,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Radiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Pathology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院儿科,510120 [2]广州医科大学附属第一医院检验科,510120 [3]广州医科大学附属第一医院放射科,510120 [4]广州医科大学附属第一医院病理科,510120

出　　处：《国际呼吸杂志》2020年第7期531-535,共5页International Journal of Respiration

基　　金：国家自然科学基金(81770063);广州市科技创新项目(201607010373)。

摘　　要：目的探讨儿童肺部侵袭性真菌感染的临床表现、治疗与预后。方法回顾性分析广州医科大学附属第一医院儿科2012年1月至2018年8月93例拟诊及确诊为肺部侵袭性真菌感染的儿童患者的临床表现、影像学表现、实验室检查、治疗及预后。结果93例真菌患者中男64例,女29例;年龄(55.18±5.38)个月,年龄范围为1个月至15岁,中位年龄32个月。所有患儿平均住院天数为25.4 d,住院天数中位数为23 d。所有患者临床表现无特异性,主要表现为发热、咳嗽、咳痰、气促、呼吸困难。肺部影像学表现形态多样,主要为肺纹理稍增粗/增多,纹理间可见斑点或斑片状模糊影,并伴有肺实变、弥漫性结节样变等,支气管扩张及纵隔淋巴结肿大较少见。93例患者中血/深部痰真菌培养阳性者41例(44.1%),其中念珠菌属阳性者22例(53.6%)部分患者同时培养出2种不同真菌。93例患儿中,抗真菌治疗有效72例(77.4%),因基础疾病严重放弃治疗8例(8.6%),转院治疗6例(6.5%),死亡7例(7.5%)。其中,单用或联合使用伏立康唑抗真菌感染41例(44.1%),有效38例(92.7%),死亡3例(7.3%)。结论儿童肺部侵袭性真菌感染好发于伴有严重基础性疾病的患儿,其临床表现及影像学表现无特异性,病死率和预后与宿主因素、环境因素及抗真菌治疗密切相关,使用伏立康唑抗真菌治疗能有效降低儿童肺部真菌感染的病死率。Objective To explore the clinical manifestations,treatment and prognosis of pulmonaryinvasive fungal infection in children.Methods The clinical,imaging,laboratory examination,treatment and prognosis of 93 children with pulmonary invasive fungal infection that were to be diagnosed or confirmed in the Department of Pediatrics,the First Affiliated Hospital of Guangzhou Medical University,from January 2012 to August 2018 were analyzed retrospectively.Results Among the 93 fungal patients,64 were male and 29 were female,with an age of(55.18±5.38)months,ranging from one month to 15 years,and a median age of 32 months.The average length of stay was 25.4 days,and the median length of stay was 23 days.The clinical manifestations of all patients were nonspecific,including fever,cough,expectoration,shortness of breath and dyspnea.The pulmonary imaging features were diverse,mainly including slightly thickened/increased lung texture,spot or patchy fuzzy shadow between the textures,accompanied by pulmonary consolidation,diffuse nodular change,etc.Bronchiectasis and mediastinal lymph node were rare.Among the 93 patients,41 cases(44.1%)were positive for fungal culture in blood/deep sputum,and 22 cases(53.6%)were positive for Candida,two kinds of fungi were cultured in some patients at the same time.72 cases(77.4%)were effective in antifungal therapy,eight cases(8.6%)were abandoned because of basic diseases,six cases(6.5%)were transferred to other hospital,senven cases(7.5%)died.Among them,41 cases(44.1%)were treated with voriconazole alone or in combination,38 cases(92.7%)were effective,and three cases(7.3%)died.Conclusions Children with pulmonary invasive fungal infection are more likely to occur in children with serious underlying diseases.Their clinical and imaging manifestations are nonspecific.The mortality and prognosis are closely related to host factors,environmental factors and antifungal treatment.The use of voriconazole antifungal treatment can effectively reduce the mortality of children with pulmonary fungal infecti

关 键 词：肺疾病 真菌性 肺炎 儿童 临床分析 治疗 

分 类 号：R72[医药卫生—儿科]