53例血液病患者伴发肺部侵袭性真菌感染临床分析

目的:探讨血液病伴发肺部侵袭性真菌感染(IFI)患者临床特点、抗真菌药物疗效和不良反应。方法:回顾性分析53例IFI患者临床表现、真菌学特征和抗真菌治疗结果。结果:53例患者均有不同程度发热,其中5例伴特异性胸痛和气促。CT表现复杂,7例(13.2%)伴肺部空洞或结节,5例(9.4%)呈现"晕轮征"或"新月形空气征"样改变。共检出真菌株27例,主要包括白色念珠菌9例(33.3%),热带念珠菌5例(18.5%),曲霉菌5例(18.5%)。55例患者治疗15~79 d,8例(15.1%)患者均因为感染难以控制或疾病进展死亡。结论:血液病伴发肺部IFI患者临床特征缺乏特异性,以白色念珠菌感染常见,CT辅助检查对IFI诊断和经验性治疗有重要参考价值。

Clinical features of invasive fungal infection in 53 patients with hematolog-ical malignancies

Objective:To investigate clinical features of invasive fungal infection (IFI)in patients with hematological malignan-cies,and to evaluate the effect and safety of antifungal agents.Methods:The clinical manifestations,mycological features,and the thera-peutic results of IFI 53 patients were retrospectively analyzed.Results:All patients were accompanied with fever,in which 5 cases with specific chest pain and anhelation.All IFI patients presented abnormal radiological characters.Lung CT image showed nodules /cavities, typical halo sign and /or air crescent sign,accounting for 13.2%(7 /53)and 9.4%(5 /53),respectively.Out of 27 fungal strains isola-ted,9 cases were candida albicans,5 cases were candida tropicalis and 5 cases were aspergillus,accounting for 33.3%,18.5% and 18.5%,respectively.A total of eight patients (15.1 %)died as uncontrolled infection or progressive disease.Conclusion:IFI patient with hematological malignancies shows non-specific clinical features,and CT imaging is valuable for diagnosis and empirical therapy of IFI.