儿童急性白血病合并毛霉病5例临床分析  

Pediatric acute leukemia complicated with mucormycosis:a clinical analysis of 5 cases

作　　者：朱成琳 许喆 王敏 韦楠 陈天平 汪俭 屈丽君 ZHU Chenglin;XU Zhe;WANG Min;WEI Nan;CHEN Tianping;WANG Jian;QU Lijun(Department of Hematology and Oncology,Anhui Provincial Children's Hospital,Hefei,Anhui 230051,China)

机构地区：[1]安徽省儿童医院血液肿瘤科,安徽合肥230051

出　　处：《安徽医药》2025年第4期815-819,I0005,共6页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省卫生健康科研项目(AHWJ2023Bba20030)。

摘　　要：目的探讨5例急性白血病合并毛霉病病儿的临床特点及治疗过程,以期为临床诊治提供参考。方法回顾性分析2022年5月至2023年7月5例因急性白血病在安徽省儿童医院接受治疗并发生毛霉病病儿的临床资料,所有病儿均经G试验、影像学检查并结合临床症状确诊,总结其临床特征、诊疗及预后。结果5例病儿中,男3例,女2例,中位年龄12(5,13)岁。3例为急性淋巴细胞白血病,2例为急性髓系白血病。4例为肺型毛霉病,1例为皮肤型毛霉病。5例病人均通过宏基因组二代测序(mNGS)检测出病原菌,其中3例为灰色小克银汉霉属,1例为小孢根霉,1例为德氏根霉。4例肺型毛霉病病儿表现为发热、咳嗽,肺部影像改变前期主要为团块状高密度影,后期出现空气新月征及中央坏死腔。1例皮肤型毛霉病临床表现为发热、黑色焦痂样皮损。3例给予静脉两性霉素B脱氧胆酸盐(AmBd)联合泊沙康唑口服治疗,1例给予AmBd联合伏立康唑口服,1例给予艾沙康唑口服。5例病儿中1例痊愈,3例好转,1例好转后死于原发病进展。结论急性白血病儿童合并毛霉病病情进展迅速,mNGS可为启动目标治疗提供方向。Objective To investigate the clinical characteristics and treatment process of 5 children with acute leukemia complicated with mucormycosis,in order to provide reference for clinical diagnosis and treatment.Methods Clinical data of 5 children with mucormycosis who received treatment for acute leukemia in Anhui Provincial Children's Hospital from May 2022 to July 2023 were retrospectively analyzed.All patients were confirmed by G test,imaging examination and clinical symptoms.The clinical features,diagnosis,treatment and prognosis were summarized.Results Among the five children,there were three boys and two girls,with a median age of 12(5,13)years.Three cases had acute lymphoblastic leukemia,while two had acute myelogenous leukemia.Four children suffered from pulmonary mucormycosis,and one had cutaneous mucormycosis.All five patients had pathogens detected by metagenomic nextgeneration sequencing(mNGS),of which three were identified as Cunninghamella bertholletiae,one as Rhizopus microsporus,and one as Rhizopus delemar.The four patients with pulmonary mucormycosis mainly presented with fever and cough,with early pulmonary imaging showing mass-like high-density shadows,while later-stage imaging showing air crescent signs and central necrotic cavities.The patient with cutaneous mucormycosis presented with fever and black eschar-like skin lesions.Initial treatment for three patients included intravenous administration of amphotericin B deoxycholate(AmBd)in combination with oral posaconazole,one patient received administration of AmBd combined with voriconazole orally,and one patient was treated with oral isavuconazole.Of the five patients,one was cured,three improved,and one died due to progression of leukemia after initial improvement.Conclusion The clinical presentation of children with acute leukemia complicated with mucormycosis progresses rapidly,and mNGS can provide guidance for initiating targeted therapy promptly.

关 键 词：急性白血病 毛霉病 宏基因组二代测序 儿童 化疗 

分 类 号：R733.71[医药卫生—肿瘤] R725.1[医药卫生—临床医学]