二性霉素B联用伊曲康唑经验性治疗血液病患儿并发肺部真菌感染22例

目的探讨血液病患儿并发肺部真菌感染的诊断和治疗。方法对22例采用二性霉素B和伊曲康唑治疗的血液病患儿的临床资料进行回顾性分析。结果22例中10例有呼吸道症状，17例胸部X线片检查可见大小不等的点片状阴影，3例胸部CT检查可见云絮状影；10例白色念珠菌感染，1例曲霉菌感染；6例（27．3％）中性粒细胞〈0．5×10^9／L，9例（40．9％）〈0．1×10^9／L；18例使用糖皮质激素（除外输注血液制品偶尔使用者）；所有真菌感染病例均采用广谱抗生素联合二性霉素B雾化吸人治疗5d以上；5d后症状无改善者加用伊曲康唑治疗2周以上；有效率为59．1％（13／22），仅1例死亡。结论血液病患儿并发肺部真菌感染与强烈化疗、中性粒细胞减少、广谱抗生素的应用有关，早期诊断较困难。经验性二性霉素B和伊曲康唑治疗疗效确切，值得推广。

Experimental therapy of pulmonary fungal infection with amphotercin B and itraconazole in 22 cases of childhood hematological diseases

Objective To explore the diagnosis and therapy of pulmonary fungal infection in childhood hematological diseases. Methods A retrospectively clinical analysis was carried out in 22 cases of childhood hematological diseases treated with amphotercin B and itraconazole. Results 10 out of 22 cases had the respiratory manifestations. X rays in chests showed shadows with features of stigma and sheet in 17 cases. Candida albicans and aspergillus infection were observed in 10 and 1 cases respectively. The numbers of neutrophil were below 0.5×109/L in 6 cases and below 0.1×109/L in 9 cases respectively. 18 cases were treated with glucocorticoid except for those occasionally application in blood transfusion. Intravenous dripping broad spectrum antibiotics and inhaling amphotericin B were used for more than 5 days in all cases. Itraconazole was used for more than 2 weeks after clinical symptoms were not improved 5 days later. The results showed that clinical symptoms of 13 cases were improved within two weeks and only 1 case died. Conclusion The occurrence of pulmonary fungal infection in childhood hematological diseases is associated with intensive chemotherapy, neutropenia and usage of broad spectrum antibiotics. Experimental therapy with amphotercin B and intraconzole is effective and worth of being widely spread.