恶性血液病合并侵袭性真菌病的感染特点分析  

Analysis of the infection characteristics of malignant hematological diseases combined with invasive fungal diseases

作　　者：曹圣晗 赵子剑 CAO Shenghan;ZHAO Zijian(Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;First Teaching Hospital of Tianjin University of Traditional Chinese Medicine)

机构地区：[1]天津中医药大学,天津301617 [2]天津中医药大学第一附属医院

出　　处：《中国病原生物学杂志》2024年第11期1331-1335,共5页Journal of Pathogen Biology

摘　　要：目的通过分析恶性血液病合并侵袭性真菌病(IFD)患者的临床特征、病原菌分布情况,探讨恶性血液病合并IFD的感染特点及伏立康唑临床疗效。方法利用电子病例系统收集接诊的65例恶性血液病合并IFD患者临床资料及伏立康唑治疗情况。采集患者痰液、粪便、尿液、血液、咽拭子等分泌物标本,培养分离后,根据不同颜色、菌落形态、镜下形态特征等鉴定菌株类型。抗菌治疗后,分析临床疗效及不良反应发生情况。结果65例恶性血液病合并IFD患者,主要为急性髓系白血病(33.85%,33/65)与非霍奇金淋巴瘤(20.00%,13/65)。65例患者中,确诊IFD3例,临床诊断IFD 18例,拟诊断44例。感染部位主要分布在肺部(47例)和肠道(7例)。肺部IFD患者症状主要为咳嗽、咳痰、胸闷、气短,痰液呈拉丝状,部分患者出现发热;肠道IFD患者症状主要为腹痛、腹泻、大便呈蛋花样;食道IFD患者症状为恶心、进食后胸部疼痛;血液IFD患者症状为持续发热、畏寒。采集患者分泌物进行真菌培养,其中痰液标本的检出率为24.62%,高于其他标本。共检出的21株真菌菌株,其中白色假丝酵母菌11株,热带假丝酵母菌5株,克柔假丝酵母菌2株,光滑假丝酵母菌、黑曲霉、黄曲霉各1株。65例患者中,36例患者仅给予伏立康唑口服剂型,14例患者仅给予伏立康唑注射剂型,10例患者先给予伏立康唑注射剂型、后给予伏立康唑口服剂型治疗,5例患者先给予伏立康唑口服剂型、后给予伏立康唑注射剂型治疗。12例患者未联用抗细菌药,15例患者联用一种抗细菌药,18例患者联用两种抗细菌药,20例患者联用三种抗细菌药。30例为预防用药,23例为诊断驱动用药,7例为经验用药,5例为目标用药。预防用药组有效率为96.67%,诊断驱动用药组有效率73.91%,经验用药组有效率71.43%,目标用药组有效率60%,差异有统计学意义(P<0.05)。65例患者中,共18例患者Objective By analyzing the clinical characteristics and distribution of pathogenic bacteria in patients with malignant hematological diseases combined with invasive fungal diseases,this study explored the infection characteristics of malignant hematological diseases combined with invasive fungal diseases and the clinical efficacy of voriconazole.Methods The clinical data and treatment status of 65 patients with malignant hematological diseases and invasive fungal diseases were collected by an electronic case system.The secretion samples such as sputum,feces,urine,blood,and throat swabs from patients collected.After culture and isolation,the types of strains were identified according to different colors,colony morphology,microscopic morphological characteristics,etc.After antibacterial treatment,the clinical efficacy and the occurrence of adverse reactions were analyzed.Results 65 patients with malignant hematological diseases combined with IFD,mainly acute myeloid leukemia(33.85%,33/65)and non Hodgkin's lymphoma(20.00%,13/65).Among 65 patients,3 were diagnosed with IFD,18 were clinically diagnosed with IFD,and 44 were planned to be diagnosed.The infection sites were mainly distributed in the lungs(47 cases)and the intestines(7 cases).The main clinical symptoms of pulmonary IFD patients were cough,expectoration,chest tightness,and shortness of breath,the sputum was pulled like,and some patients experience fever;the main clinical symptoms of intestinal IFD patients were abdominal pain,diarrhea,and egg shaped stools;the clinical symptoms of esophageal IFD patients were nausea and chest pain after eating,while the clinical symptoms of blood IFD patients were persistent fever and fear of cold.The multiple secretions were collected for fungal culture,with a detection rate of 24.62%in sputum samples,which was higher than other samples.A total of 21 fungal strains were detected,including ll strains of Candida albicans,5 strains of C.tropicalis,2 strains of C.krusei,and 1 strain of C.glabrata,Aspergillus niger,and A.flaou

关 键 词：恶性血液病 侵袭性真菌病 伏立康唑 

分 类 号：R733[医药卫生—肿瘤] R519[医药卫生—临床医学]