血液病患者合并肝脾念珠菌病的临床特征及预后  

Clinical features and prognosis of hepatosplenic candidiasis in patients with hematopathy

作　　者：朱丹苹 马瑞 何云[1] 罗雪宜 韩伟[1] 李川 周婧睿 廖益 唐博瑞 龙卡龙通 黄晓军[1] 孙于谦[1] Zhu Danping;Ma Rui;He Yun;Luo Xueyi;Han Wei;Li Chuan;Zhou Jingrui;Liao Yi;Tang Borui;Longka Longtong;Huang Xiaojun;Sun Yuqian

机构地区：[1]北京大学人民医院,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,造血干细胞移植治疗血液病北京市重点实验室,北京100044

出　　处：《中华血液学杂志》2024年第7期683-688,共6页Chinese Journal of Hematology

基　　金：国家自然科学基金(8227010768);科技部重点研发计划(2021YFC2500300)。

摘　　要：肝脾念珠菌病是一种罕见的念珠菌病类型,可发生在血液系统恶性肿瘤、造血干细胞移植患者中,然而目前仍缺乏中国血液病合并肝脾念珠菌病患者的相关研究。本研究依据2020年《血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第六次修订版)》的诊断标准,回顾性分析了2008年至2022年在北京大学血液病研究所接受治疗并合并肝脾念珠菌病患者的临床特点及预后。研究最终共有18例患者诊断为肝脾念珠菌病,包括确诊1例(5.6%)、临床诊断2例(11.1%)、拟诊15例(83.3%)。其中3例(16.7%)患者发生在单倍体造血干细胞移植后,15例(83.3%)患者发生在化疗后。6例(33.3%)患者血培养阳性,其中热带念珠菌4例,白念珠菌2例。抗真菌治疗4周时,10例(58.8%)患者达部分缓解;8周时1例(6.3%)达完全缓解,10例(62.5%)达部分缓解。诊断后6个月时,3例(16.7%)患者死于血液学复发,没有患者死于肝脾念珠菌病。肝脾念珠菌病作为一种罕见的真菌感染性疾病,具有微生物学检查和组织学检查阳性率较低、治疗周期长、不易缓解等特点,在伴有持续发热的血液病患者中需警惕肝脾念珠菌病的发生。Hepatosplenic candidiasis(HSC)is a rare type of candidiasis that can occur in patients with hematologic malignancies,hematopoietic stem cell transplantation.At present,there is still a lack of studies on HSC in patients with hematologic disorders.Based on The Chinese Guidelines for the Diagnosis and Treatment of Invasive Fungal Disease in Patients with Hematological Disorders and Cancers(the 6th revision),We retrospectively analyzed the clinical characteristics and prognosis of patients with HSC treated in Peking University Institute of Hematology from 2008 to 2022.Finally,eighteen patients were included,with 1(5.6%)proven,2(11.1%)probable,and 15(83.3%)possible HSC.Among them,3(16.7%)patients occurred after haploid hematopoietic stem cell transplantation and 15(83.3%)patients occurred after chemotherapy.6(33.3%)patients had positive blood cultures,including 4 cases of Candida tropicalis and 2 cases of Candida albicans.At 4 weeks of antifungal therapy,10(58.8%)patients achieved partial response(PR),At 8 weeks,1(6.3%)patients achieved complete response and 10(62.5%)patients achieved PR.At 6 months after diagnosis,3(16.7%)patients died of hematopoietic recurrence,and none of them died of HSC.As a rare fungal infection disease,HSC has a low positive rate of microbiological and histological examinations,a persistent treat cycle,and has difficulty in remission,reminding us of the need for vigilance in patients with hematopoietic disorders and persistent fever.

关 键 词：血液病患者 血培养阳性 真菌感染性疾病 侵袭性真菌病 抗真菌治疗 诊断标准 念珠菌病 微生物学检查 

分 类 号：R552[医药卫生—血液循环系统疾病] R519.3[医药卫生—内科学]