急性白血病并发侵袭性肺曲霉病的临床分析

目的]探讨急性白血病（AL）并发侵袭性肺曲霉病（IPA）的临床特点、诊断及治疗。方法]回顾性分析7例AL并发IPA病例的临床资料。结果]7例AL患者强烈化疗后第8.6d（4～11d）出现中性粒细胞（ANC）缺乏（ANC〈0.5×10^9/L）,粒细胞缺乏持续时间达15d（6～20d）,并在此期间出现持续发热、咳嗽、少痰、痰中带血、胸痛等症状;在发热后6d（3～10d）行CT检查均发现胸膜下结节或肺内多发结节影,呈晕征改变,2例伴有类圆形空洞病灶;4例行痰培养发现烟曲霉菌。4例患者予两性霉素B治疗,2例好转,1例疗效欠佳改用卡泊芬净后好转,1例因并发肾功能衰竭死亡;另外3例患者予伏立康唑治疗后好转。6例好转者随访中位时间18个月未见复发。结论]粒细胞缺乏是IPA发病的高危因素,CT检查有助于IPA的早期诊断。伏立康唑是治疗IPA的首选药物,其有效性及安全性均优于两性霉素B。

Clinical Study of Invasive Pulmonary Aspergillosis in Patients with Acute Leukemia

Purpose] To investigate the clinical manifestations,diagnosis and treatment of invasive pulmonary aspergillosis （IPA） in patients with acute leukemia （AL）. Methods] The clinical data from 7 cases with AL complicated IPA were retrospectively analyzed. Results] Of the 7 cases,agranulocytosis （ANC0.5×109/L） occurred at 8.6 （4～11） days after intensive chemotherapy and lasted for 15（6～20） days. All the 7 cases developed persistent fever,cough,chest pain and hemop-tysis during the neutropenic period. CT was carried out at the 6th（3～10） day after fever beginning. Multi-nodular shadows accompanied with Halo-sign in lung were detected with spherical-like cavity in 2 cases. Aspergillus fumigatus was found by sputum culture in 4 cases. Four cases received amphotericin B therapy. The course of disease took a favorable turn in 2 cases. Because of failure to the drug caspofungin was replaced in 1 case. One case died of renal failure. The other 3 cases recovered after voriconazole treatment. Of the 6 recovered cases,no recurrence occurred in 18 months median follow-up period. Conclusion] Agranulocytosis is one of the risk factors of IPA,CT is helpfull to make early diagnosis for IPA. Voriconazole is the first choice therapy for IPA which is safe and more effective than Amphoteriein B.