多发性骨髓瘤并发侵袭性真菌感染的临床特征及疗效分析  

Clinical characteristics and therapeutic effect of multiple myeloma complicated with invasive fungal infection

作　　者：毛沛沛[1] 乔莎 贺莹 MAO Pei-pei;QIAO Sha;HE Ying(Department of Hematology,Nanyang Central Hospital,,Nanyang 473000,China)

机构地区：[1]南阳市中心医院血液内科,河南南阳473000

出　　处：《中国病原生物学杂志》2022年第11期1345-1348,1355,共5页Journal of Pathogen Biology

摘　　要：目的探讨和研究多发性骨髓瘤并发侵袭性真菌感染的临床特征及常用真菌抗生素疗效。方法回顾性分析参与本次研究患者的基本资料,分析多发性骨髓瘤并发侵袭性真菌感染患者的发病率、感染部位、临床症状及病原学检出情况。对比分析米卡芬净治疗组与两性霉素B治疗组两组患者的治疗效果及不良反应发生率。结果2017年1月-2021年12月,518例多发性骨髓瘤患者中21例并发侵袭性真菌感染,主要为DS-Ⅲ期,IgG-λ型,拟诊14例,G实验阳性11例。多发性骨髓瘤并发侵袭性真菌感染的五年平均发病率为4.05%,2017-2021年发病率分别为2.11%、2.97%、5.62%、4.46%和4.96%,逐年递增,其中2019年发病率最高。21例并发侵袭性真菌感染患者,80.95%为单器官感染,主要为肺部感染。95.24%患者出现发热症状,不同部位侵袭性真菌感染患者,其临床症状不同。采集21例并发侵袭性真菌感染患者的分泌物标本,共分离菌株24株,主要为白色念珠菌和曲霉菌。不同标本的检出率不同,其中痰液标本的检出率最高,为71.43%。对比分析接受米卡芬净与两性霉素B治疗的患者情况,两组治疗效果无差异,两组不良反应发生率差异有统计学意义(P<0.05)。结论多发性骨髓瘤并发侵袭性真菌感染患者主要为IgG-λ型,五年平均发病率为4.05%,多发生于肺部,以白色念珠菌感染为主。米卡芬净与两性霉素B对多发性骨髓瘤并发侵袭性真菌感染的治疗有效率均高于70%,两性霉素B不良反应高于米卡芬净。Objective To investigate the clinical characteristics of multiple myeloma complicated with invasive fungal infection and the efficacy of commonly used fungal antibiotics.Methods The basic data of the patients participating in this study were retrospectively analyzed,and the incidence rate,infection site,clinical symptoms and pathogenic detection of patients with multiple myeloma complicated with invasive fungal infection were analyzed.The therapeutic effect and adverse reaction rate of micafungin treatment group and amphotericin B treatment group were compared and analyzed.Results From January 2017 to December 2021,21 of 518 multiple myeloma patients were complicated with invasive fungal infection,mainly DS-Ⅲ,IgG-λType A,14 cases were suspected,11 cases were G test positive.The five-year average incidence rate of multiple myeloma complicated with invasive fungal infection is 4.05%,and the incidence rate from 2017 to 2021 is 2.11%,2.97%,5.62%,4.46%and 4.96%respectively,increasing year by year,with the highest incidence rate in 2019.Among 21 patients with invasive fungal infection,80.95%were single organ infection,mainly pulmonary infection.95.24%patients had fever symptoms,and the clinical symptoms of patients with invasive fungal infection in different parts were different.The secretion samples of 21 patients with invasive fungal infection were collected.A total of 24 strains were isolated,mainly Candida albicans and Aspergillus.The detection rate of different specimens was different,and the detection rate of sputum specimen was the highest,71.43%.Comparative analysis of patients receiving micafungin and amphotericin B treatment showed that there was no significant difference between the two treatment groups in terms of treatment effect(P>0.05),and there was a significant difference in the incidence of adverse reactions between the two groups(P<0.05).Conclusion Multiple myeloma patients with invasive fungal infection are mainly IgG-λThe five-year average incidence rate was 4.05%,mostly occurred in the lungs,m

关 键 词：多发性骨髓瘤 并发侵袭性真菌感染 临床特征 治疗效果 

分 类 号：R378[医药卫生—病原生物学]