实用癌症杂志
實用癌癥雜誌
실용암증잡지
THE PRACTICAL JOURNAL OF CANCER
2014年
5期
592-595
,共4页
恶性血液病%化疗%伏立康唑%真菌性败血症%白色念珠菌
噁性血液病%化療%伏立康唑%真菌性敗血癥%白色唸珠菌
악성혈액병%화료%복립강서%진균성패혈증%백색념주균
Hematological malignancies%Chemotherapy%Voriconazole%Fungal sepsis%Candida albicans
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。
目的：分析噁性血液病化療後閤併真菌性敗血癥的臨床病理特徵。方法迴顧性分析化療後180例噁性血液病患者的臨床資料。結果180例中有10例患者化療後閤併真菌性敗血癥，其中男性7例，女性3例，髮生率為5．5％，中位年齡40．3歲（16～78歲），原髮疾病分彆為急性淋巴細胞白血病4例，急性髓繫白血病3例，多髮性骨髓瘤、非霍奇金淋巴瘤及噬血細胞綜閤徵各1例。從化療至齣現真菌敗血癥的時間為7～32 d，平均為17．9 d。病原菌全部為唸珠菌，包括白色唸珠菌5例、光滑唸珠菌和熱帶唸珠菌各2例、近平滑唸珠菌1例，根據藥敏試驗全部病例均應用伏立康唑註射液（4 mg/kg，2次/天）治療，8例治愈，2例因閤併肺部感染治療無效死亡，治療時間為7～35 d，平均16．5 d，總有效率為80％。結論噁性血液病化療後可閤併真菌性敗血癥，病原菌以唸珠菌為主，死亡率較高，應根據藥敏試驗結果閤理選擇抗菌藥物，進行早期經驗性抗真菌治療。
목적：분석악성혈액병화료후합병진균성패혈증적림상병리특정。방법회고성분석화료후180례악성혈액병환자적림상자료。결과180례중유10례환자화료후합병진균성패혈증，기중남성7례，녀성3례，발생솔위5．5％，중위년령40．3세（16～78세），원발질병분별위급성림파세포백혈병4례，급성수계백혈병3례，다발성골수류、비곽기금림파류급서혈세포종합정각1례。종화료지출현진균패혈증적시간위7～32 d，평균위17．9 d。병원균전부위념주균，포괄백색념주균5례、광활념주균화열대념주균각2례、근평활념주균1례，근거약민시험전부병례균응용복립강서주사액（4 mg/kg，2차/천）치료，8례치유，2례인합병폐부감염치료무효사망，치료시간위7～35 d，평균16．5 d，총유효솔위80％。결론악성혈액병화료후가합병진균성패혈증，병원균이념주균위주，사망솔교고，응근거약민시험결과합리선택항균약물，진행조기경험성항진균치료。
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'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 .
