侵袭性肺部真菌感染在实体恶性肿瘤与血液肿瘤中发病及抗菌治疗疗效的临床对比分析

目的:对比分析侵袭性肺部真菌感染（IPFI）在实体恶性肿瘤与血液肿瘤患者中的发病率、危险因素、临床特征及抗真菌治疗结果，从而提高对侵袭性肺部真菌感染诊治的认识。方法:回顾性分析2017年6月至2019年6月中国医学科学院肿瘤医院深圳医院实体恶性肿瘤或血液肿瘤合并侵袭性肺部真菌感染并进行抗真菌治疗的患者临床资料，对比两组间的危险因素、临床特征、抗真菌治疗缓解率、用药中位时间差异。结果:实体恶性肿瘤患者合并IPFI 30例，发病率0.42%；血液肿瘤患者合并IPFI 228例，发病率10.6%，差异有统计学意义（P<0.05）。实体恶性肿瘤组和血液肿瘤组男性比例分别为33.3%（10/30）和61.4%（140/228），多因素分析粒缺状态、有类固醇激素治疗、糖尿病史、慢性肺部疾病史、有咳嗽咳痰症状、G/GM试验阳性率、微生物培养阳性率差异有统计学意义，两组在年龄≥65岁、发热、呼吸困难、肺部特征性影像学表现方面无明显差异。血液肿瘤组中联合抗真菌治疗比例为35.1%（80/228），实体恶性肿瘤组无，两组患者治疗中位时间为(17.89±7.738)天和(13.55±5.176)天，总有效率为61.5%（91/148）和75%（60/80），差异有统计学意义(P<0.05)。结论:侵袭性肺部真菌感染在血液肿瘤患者中发病率更高，血液肿瘤联合抗真菌治疗疗效确切且安全，值得在实体恶性肿瘤临床进一步应用。

Comparative analysis of the incidence and efficacy of invasive pulmonary fungal infection in solid malignant tumors and hematological tumors

Objective:To compare and analyze the incidence,risk factors,clinical features and antifungal treatment results of invasive pulmonary fungal infection(IPFI)in patients with solid malignant tumors and hematological tumors,to improve the understanding of diagnosis and treatment of invasive pulmonary fungal infections.Methods:We retrospectively analyzed clinical data of patients with solid malignant tumors or hematological tumors with invasive pulmonary fungal infection and antifungal treatment from June 2017 to June 2019,Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital.We compared risk factors,clinical characteristics,response rate to antifungal therapy,and median time to medication between the two groups.Results:There were 30 patients with solid malignant tumors combined with IPFI,and the incidence rate was 0.42%.There were 228 patients with hematological tumors combined with IPFI,and the incidence rate was 10.6%.The difference was statistically significant(P<0.05).The proportion of males in the solid malignant tumor group were 33.3%(10/30).The proportion of males in the hematological tumor group were 61.4%(140/228).Multivariate analysis showed statistically significant differences in neutrophihic status,history of steroid therapy,history of diabetes,history of chronic lung disease,symptoms of cough and sputum,positive rate of G/GM test,and positive rate of microbial culture.There were no significant differences between the two group in age above 65 years,fever,dyspnea,and characteristic imaging features of the lungs.The proportion of combined antifungal therapy in the hematological tumor group was 35.1%(80/228),but not in the solid malignant tumor group.The median treatment time in the two groups was 17.89±7.738 days and 13.55±5.176 days,and the total effective rate was 61.5%(91/148)and 75%(60/80).The difference was statistically significant(P<0.05).Conclusion:Invasive pulmonary fungal infections have higher incidence in patients with hematological tumors.The efficacy of hematological tumors combined with antifungal therapy is accurate and safe,which deserves further clinical application in solid malignancies.