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目的分析急性白血病并肺部真菌感染(PFI)患儿的临床特征,探讨其早期诊断与防治策略。方法对2004年3月-2010年3月上海市儿童医院血液科收治的132例儿童急性白血病并PFI情况进行回顾性分析。其中57例患儿发生PFI 60例次,按照欧洲癌症研究和治疗组织(EORTC)标准,确诊PFI 5例次,临床诊断PFI 30例次,拟诊PFI 25例次。结果 1.急性白血病患儿中PFI的发生率为43.18%(57/132例)。发生PFI时距确认基础疾病的中位时间为7.2个月(5 d~50个月),其中≤12个月占70%(42/60例),>12个月占30%(18/60例)。2.胸部CT表现形式多样,主要表现为炎性渗出、间质改变、云絮状改变及结节影,严重者伴胸腔积液、急性呼吸窘迫综合征。3.PFI患儿中性粒细胞减少(<1.5×109L-1)占71.7%(43/60例次),其中中性粒细胞缺乏(<0.5×109L-1)占40.0%(24/60例次)。4.1,3-β-;;DOI:10.3969/j.issn.葡聚糖实验阳性占70.5%(31/44例次),阴性占29.5%(13/44例次)。57例患儿真菌培养出念珠菌7株,酵母菌2株。5.治疗有效率为95.0%(57/60例次),抗真菌单药及联合治疗有效率分别为53.3%和41.7%。结论 1.真菌感染是儿童急性白血病继发重症感染的主要病原学之一。2.胸部CT对PFI有重要的诊断价值,微生物培养在儿童中阳性率较低。3.早期诊断与及时治疗是提高PFI疗效的关键。若伴早期呼吸衰竭或呼吸窘迫综合征应及时加压给氧或辅助机械通气,可获得良好的预后。
Objective To analyze the clinical features of children with acute leukemia and pulmonary fungal infection (PFI) and to explore its early diagnosis and control strategies. Methods A retrospective analysis of 132 children with acute leukemia and PFI admitted to Department of Hematology, Shanghai Children’s Hospital from March 2004 to March 2010 was retrospectively analyzed. Fifty-seven patients had PFI 60 times. According to the European Organization for Research and Treatment of Cancer (EORTC) criteria, 5 cases of PFI were diagnosed, 30 cases of PFI were diagnosed clinically, and 25 cases of PFI were diagnosed. The incidence of PFI in children with acute leukemia was 43.18% (57/132 cases). The median time to PFI was 7.2 months (ranged from 5 days to 50 months) when PFI occurred, with 70% (42/60) in ≤12 months and 30%> 12 months (18/60 example). Chest CT manifestations varied, mainly as inflammatory exudate, interstitial changes, flocculent changes and nodules, severe cases with pleural effusion, acute respiratory distress syndrome. Neutropenia (<1.5 × 109 L-1) in 71 cases of children with PFI accounted for 71.7% (43/60 cases), of which neutropenia (<0.5 × 109 L -1) accounted for 40.0% (24/60 Cases). 4.1,3-β - ;; DOI: 10.3969 / j.issn. The positive results of dextran assay were 70.5% (31/44 cases) and the negative cases were 29.5% (13/44 cases). 57 cases of fungi cultured Candida 7 strains, yeast 2 strains. The effective rate was 95.0% (57/60 cases). The effective rates of antifungal monotherapy and combination therapy were 53.3% and 41.7% respectively. Fungal infection is one of the major etiology of secondary infection of acute leukemia in children. Chest CT has important diagnostic value for PFI, and the positive rate of microbial culture in children is low. 3. Early diagnosis and timely treatment is the key to improve the efficacy of PFI. If with early respiratory failure or respiratory distress syndrome should be promptly pressurized oxygen or assisted mechanical ventilation, get a good prognosis.