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目的明确化疗后患者发生肺孢子菌病(PCP)的危险因素;为急性白血病FLAG方案[氟达拉滨30 mg/(m2.d),第1～5天;阿糖胞苷1～2 g/(m2.d),第1～5天;粒细胞刺激因子5μg/(kg.d),d1～d5)]化疗后肺孢子菌病的预防和治疗提供依据。方法回顾性分析6例白血病化疗后发生肺孢子菌病患者的临床特点,分析发生肺孢子菌病患者的临床特点。结果 6例患者中急性淋巴细胞白血病2例,急性非淋巴细胞白血病4例;患者年龄14～19岁、体质量指数14～18 kg/m2,发生PCP前3个化疗方案中均至少包含2个FLAG方案;PCP起病时均出现明显呼吸困难和血氧饱和度降低,PCP发病时间大约在患者外周血中性粒细胞数恢复后3 d,发病时淋巴细胞和CD4+T淋巴细胞数量和比例明显减少,6例患者均采用复方磺胺甲基异恶唑+棘白霉素类药物联合治疗,症状于1周内好转。结论急性白血病患者应用FLAG方案化疗后,当患者年龄14～19岁、体型偏瘦时,在中性粒细胞恢复后,需监测CD4+T淋巴细胞数量,出现CD4+T细胞数量明显减低时,需密切留意肺孢子菌病的防治。
Objective To clarify the risk factors of pneumocystis disease (PCP) after chemotherapy in patients with acute leukemia FLAG regimen [fludarabine 30 mg / (m2.d), days 1 to 5; cytarabine 1 ~ 2 g /(m2.d), days 1 to 5; granulocyte stimulating factor 5μg / (kg.d), d1 ~ d5)] provide the basis for the prevention and treatment of pneumocystis disease after chemotherapy. Methods The clinical features of 6 patients with Pneumocystis disease after chemotherapy were retrospectively analyzed. The clinical features of patients with Pneumocystis disease were analyzed. Results There were 2 cases of acute lymphoblastic leukemia and 4 cases of acute non-lymphocytic leukemia in 6 patients. The patients were 14 to 19 years of age with a body mass index of 14 to 18 kg / m2. There were at least 2 FLAG program; PCP onset were significantly dyspnea and decreased oxygen saturation, PCP onset about the patient’s peripheral blood neutrophils recovered 3 d after onset, the incidence of lymphocytes and CD4 T lymphocytes in the number and proportion Significantly reduced, 6 patients were treated with compound sulfamethoxazole + spiramycin combination therapy, the symptoms improved within 1 week. Conclusions When the patients with acute leukemia are treated with FLAG regimen, the number of CD4 + T lymphocytes to be monitored after neutrophil recovery when the patients are 14 to 19 years of age and the body is lean in body mass, and the number of CD4 + T cells is significantly decreased, Need to pay close attention to the prevention and treatment of pneumosporidiosis.