摘要
目的：分析恶性血液病化疗后合并真菌性败血症的临床病理特征。方法回顾性分析化疗后180例恶性血液病患者的临床资料。结果180例中有10例患者化疗后合并真菌性败血症，其中男性7例，女性3例，发生率为5．5％，中位年龄40．3岁（16～78岁），原发疾病分别为急性淋巴细胞白血病4例，急性髓系白血病3例，多发性骨髓瘤、非霍奇金淋巴瘤及噬血细胞综合征各1例。从化疗至出现真菌败血症的时间为7～32 d，平均为17．9 d。病原菌全部为念珠菌，包括白色念珠菌5例、光滑念珠菌和热带念珠菌各2例、近平滑念珠菌1例，根据药敏试验全部病例均应用伏立康唑注射液（4 mg/kg，2次/天）治疗，8例治愈，2例因合并肺部感染治疗无效死亡，治疗时间为7～35 d，平均16．5 d，总有效率为80％。结论恶性血液病化疗后可合并真菌性败血症，病原菌以念珠菌为主，死亡率较高，应根据药敏试验结果合理选择抗菌药物，进行早期经验性抗真菌治疗。
Objective To study the characteristics of hematological malignancies after chemotherapy with fungal sepsis . Methods Clinical data of 180 patients with hematological malignancies who received chemotherapy were retrospectively ana -lyzed.Results Among 180 patients,10 patients had fungal sepsis after chemotherapy ,including 7 males and 3 females,the inci-dence rate was 5.5%,with a median age of 40.3 years （16 to 78 years）.There were 4 cases of acute lymphoblastic leukemia ,3 acute myeloid leukemia,1 multiple myeloma,1 non-Hodgkin＆#39;s lymphoma,and 1 hemophagocytic syndrome.Fungal sepsis appeared 7~32 days after chemotherapy ,average time was 17.9 days.Pathogens were all candida ,including 5 cases of candida albicans ,2 cases of candida glabrata ,2 cases of candida tropicalis and 1 cases of candida parapsilosis .According to the drug sensitivity test , voriconazole（4 mg/kg,2/d） antifungal therapy was selected .The average treatment time was 16.5d （7~35 days）,8 patients were cured and 2 patients died of lung infection .The total effective rate was 80%.Conclusion Hematologic malignancies can develop fungal sepsis after chemotherapy and major pathogens is candida .The mortality rate is higher and early empirical antifun-gal therapy should be selected based on drug susceptibility test .
出处
《实用癌症杂志》
2014年第5期592-595,共4页
The Practical Journal of Cancer
关键词
恶性血液病
化疗
伏立康唑
真菌性败血症
白色念珠菌
Hematological malignancies
Chemotherapy
Voriconazole
Fungal sepsis
Candida albicans
