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目的总结恶性血液病患者继发侵袭性肺部真菌感染(IPFI)的临床特点。方法回顾性分析1995年1月~2008年12月在北京协和医院就诊的52例恶性血液病继发IPFI患者的临床资料。结果急性髓细胞白血病(AML)、急性淋巴细胞白血病(ALL)、非霍奇金淋巴瘤(NHL)和再生障碍性贫血(AA)患者中IPFI发病率分别为4.6%、3.2%、2.8%和2.5%。在AML继发IPFI者中,88.5%(23/26)发生于未缓解期(包括复发),11.5%(3/26)发生于完全缓解期。86.5%(45/52)恶性血液病继发IPFI者存在粒细胞缺乏或减少,67.3%(35/52)在抗真菌治疗前存在≥96 h的广谱抗生素应用。抗真菌治疗后总死亡率为13.7%(7/51)。首选氟康唑与首选伊曲康唑者一半以上因感染未控制而需更换为其他抗真菌药物。结论IPFI在恶性血液病中最常见于AML。AML未缓解、粒细胞缺乏或减少和长时间广谱抗生素应用时易发生IPFI。氟康唑与伊曲康唑的有效率偏低,需重视其他强效抗真菌药物的应用。
Objective To summarize the clinical characteristics of patients with malignant hematological disease secondary to invasive pulmonary fungal infection (IPFI). Methods The clinical data of 52 patients with malignant hematological secondary IPFI treated in Peking Union Medical College Hospital from January 1995 to December 2008 were retrospectively analyzed. Results The incidence of IPFI in patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), non-Hodgkin’s lymphoma (NHL) and aplastic anemia (AA) was 4.6%, 3.2%, 2.8% 2.5%. Among AML secondary IPFI, 88.5% (23/26) occurred in unrelieved (including relapse) and 11.5% (3/26) occurred in complete remission. 86.5% (45/52) of patients with secondary hematologic malignancy had agranulocytosis or decreased, 67.3% (35/52) had broad-spectrum antibiotics application ≥96 h before antifungal therapy. The total mortality after antifungal therapy was 13.7% (7/51). More than half of fluconazole preferred and itraconazole preferred were replaced by other antifungal agents due to uncontrolled infection. Conclusions IPFI is the most common form of AML in hematologic malignancies. AML does not relieve, IPFI is prone to occur when agranulocytosis or reduction and prolonged use of broad-spectrum antibiotics. The low efficiency of fluconazole and itraconazole, the need to pay attention to the application of other potent antifungal agents.