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目的探讨血液肿瘤患儿深部真菌感染的临床特征及其诊断和治疗。方法回顾性分析2006年1月～2011年10月210例血液肿瘤经微生物学检查证实深部真菌感染患儿的相关诱因、临床特点、真菌培养结果和治疗方案并进行分析。结果 210例患儿从血或深部分泌物中共分离出168株菌种,其中念珠菌134株,占79.7%,包括白色念珠菌102株,热带念珠菌株23,近平滑念珠菌9株;曲霉菌27株,占16.1%;假丝酵母菌5株,占3.0%;毛霉菌2株,占1.2%。其余42例根据典型的影像学改变和治疗效果诊断为真菌感染。感染部位以肺部最常见,占69.5%,主要表现为咳嗽、咯痰、气促、喘憋,CT可见大片结节状或团块状高密度影;其次为肠道和泌尿系统,分别占14.9%和10.1%,其他还有败血症和皮肤感染。210例患儿全部行抗真菌药物治疗,同时加强对症支持治疗,其中单用氟康唑者83例,单用伊曲康唑者56例,单用两性霉素B者38例,其余33例联合或先后应用上述药物治疗。治愈66例,好转78例,恶化死亡42例,24例因原发病未缓解自动出院。结论血液肿瘤患儿深部真菌感染诊断困难,最常见的感染部位为肺部,最常见的病原菌为念珠菌和曲霉菌。对于粒细胞减少发热患者抗生素治疗无效时,应及早行肺部CT检查。
Objective To investigate the clinical features, diagnosis and treatment of deep fungal infection in children with hematological malignancies. Methods Retrospective analysis of 210 patients with hematological malignancies from January 2006 to October 2011 retrospectively analyzed the relevant incentives, clinical features, fungal culture results and treatment regimens in children with deep fungal infection confirmed by microbiology. Results A total of 168 strains of bacteria were isolated from blood or deep secretions of 210 children, including 134 candida species, accounting for 79.7%, including 102 strains of Candida albicans, 23 strains of Candida tropicalis and 9 strains of Candida parapsilosis; 27 strains, accounting for 16.1%; Candida 5 strains, accounting for 3.0%; Mucormycosis 2, accounting for 1.2%. The remaining 42 patients were diagnosed as having fungal infections based on typical imaging changes and treatment effects. The most common infection in the lungs, accounting for 69.5%, mainly manifested as cough, expectoration, shortness of breath, wheezing, CT visible large nodular or massive high density; followed by the intestinal and urinary system, respectively 14.9% and 10.1%, others are sepsis and skin infections. All 210 cases were treated with antifungal drugs and symptomatic and supportive treatment. 83 cases were treated with fluconazole alone, 56 cases were given itraconazole alone, 38 cases were treated with amphotericin B alone and the other 33 cases Joint or successively with the above drug treatment. 66 cases were cured, 78 cases improved, 42 cases died of aggravating, and 24 cases were discharged automatically without remission. Conclusion The diagnosis of deep fungal infection in children with hematological malignancies is difficult. The most common site of infection is lung. The most common pathogens are Candida and Aspergillus. For patients with fever and agranulocytosis antibiotics invalid, pulmonary CT should be checked as soon as possible.