血液病合并毛霉菌感染患者的临床特征及预后分析  

Clinical Features and Prognosis of Patients with Hematological Disease Complicated with Mucor Infection

作　　者：张书芹[1] 温红霞 于海涛[2] 齐长海[3] 王静波[1] ZHANG Shu-Qin;WEN Hong-Xia;YU Hai-Tao;QI Chang-Hai;WANG Jing-Bo(Department of Hematology,Aerospace Center Hospital,Beijing 100049,China;Department of Imaging,Aerospace Center Hospital,Beijing 100049,China;Department of Pathology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院血液科,北京100049 [2]航天中心医院影像科,北京100049 [3]航天中心医院病理科,北京100049

出　　处：《中国实验血液学杂志》2021年第4期1340-1345,共6页Journal of Experimental Hematology

摘　　要：目的:探讨血液病患者合并毛霉菌感染的临床特征、治疗及预后情况。方法:回顾性分析2014年4月至2020年6月在本中心经组织病理结果诊断为毛霉菌感染的18例血液病患者的高危因素、临床特征、治疗方案和预后。结果:18例患者中男13例,女5例,平均年龄30(13-54)岁,均经过感染部位组织病理学检查确诊为毛霉菌感染,其中单纯毛霉菌感染16例,毛霉菌+曲霉菌混合感染2例;12例患者为恶性血液病,6例患者为重型再生障碍性贫血,均为长期粒细胞缺乏患者;临床表现及影像学检查结果无特异性;感染累及的常见部位为鼻窦和肺部,部分患者存在多个系统受累表现;血液病的缓解状态和患者的免疫功能恢复情况对预后有影响,所有患者均给予两性霉素B脂质体联合泊沙康唑治疗,手术联合抗真菌药物治疗15例,有效9例,无效6例;3例静脉用抗真菌药物,均无效。结论:血液病合并毛霉菌感染诊断困难,早期明确诊断后,积极改善患者原发病状态,药物联合手术治疗可改善此类患者的预后。Objective: To investigate the clinical features,treatment and prognosis of patients with hematological diseases complicated with mucor infection. Methods: The risk factors,clinical features,treatment regimen and prognosis of 18 hematological disease patients with mucor infection diagnosed by histopathology in our center from April2014 to June 2020 were retrospectively analyzed. Results: Thirteen males and five females,with an average age of 30( 13-54) years old,were diagnosed as mucor infection by histopathological examination at the site of infection,including 16 cases of mucor infection alone and 2 cases of mucor + aspergillus mixed infection. There were 12 cases with malignant hematological disease and 6 cases with severe aplastic anemia, all of whom with long-term agranulocytosis,and their clinical manifestations and imaging findings were not specific. The common sites of infection were sinuses and lungs, and some patients showed multiple systemic manifestations. The remission status of hematological diseases and recovery of immune function showed an impact on the prognosis. All the patients were treated with amphotericin B liposome combined with posaconazole,and 15 patients were treated with surgery combined with antifungal drugs,9 of whom were effective and 6 were ineffective,while intravenous administration in 3 cases was ineffective. Conclusion: It is difficult to diagnose hematological disease complicated with mucor infection. After early diagnosis,prognosis can be improved by amelioration of primary state and combination of drugs and surgery.

关 键 词：血液病 毛霉菌病 治疗 预后 

分 类 号：R733[医药卫生—肿瘤] R519[医药卫生—临床医学]