| 庞淯阳,袁丽粉,俞夜花,司 阳,邹丽芳.21例淋巴瘤合并肺部侵袭性真菌感染的回顾性临床分析[J].,2021,(12):2267-2270 |
| 21例淋巴瘤合并肺部侵袭性真菌感染的回顾性临床分析 |
| Clinical Analysis of Invasive Pulmonary Fungal Infection in Patients with Twenty-one non-Hodgkin's Lymphoma |
| 投稿时间：2021-02-05 修订日期：2021-02-28 |
| DOI：10.13241/j.cnki.pmb.2021.12.015 |
| 中文关键词: 淋巴瘤、肺部侵袭性真菌感染、临床症状、危险因素、治疗 |
| 英文关键词: Lymphoma Invasive pulmonary fungal infection Clinical features Antifungal therapy |
| 基金项目:国家自然科学基金项目（81500081）；上海交通大学医学院附属第九人民医院临床研究型MDT项目（201902） |
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| 中文摘要: |
| 摘要 目的：探讨淋巴瘤合并肺部侵袭性真菌感染( IPFI ) 的高危因素、临床特征和诊疗方案。方法：回顾性分析2019-2020年血液科收治的淋巴瘤合并IPFI患者的临床资料。结果：化疗后出现IPFI的淋巴瘤患者共计21例，总发病率为2.7%，平均年龄60岁，男性占77.8%，其中确诊5例、临床诊断7例、拟诊8例，确诊患者的病原菌为白色念珠菌（80%）和曲霉菌（20%）。肺部CT影像特征不典型，大多表现为弥漫、散在的斑片状絮样密度增高影、结节影，双肺受累多见，在接受一线抗真菌治疗后有18例患者缓解，总有效率为90.4%，其中原发病终末期患者及合并细菌感染患者死亡率高，预后差。结论：老年、男性、原发病控制不佳、高强度或大剂量化疗以及糖皮质激素的使用可能是淋巴瘤IPFI的高危因素，早期临床症状和影像学检查缺乏特异性，常规病原学检出率仍较低，1-3-β-D-葡聚糖试验（G试验）、半乳甘露聚糖试验（GM试验）结合肺部CT检查有助于早期诊断，一线抗真菌药物的使用可显著改善患者预后。 |
| 英文摘要: |
| ABSTRACT Objective: To summarize the clinical features of invasive pulmonary fungal infection (IPFI) in patients with lymphoma after chemotherapy. Methods: We retrospectively analyzed the clinical data of lymphoma patients with IPFI. Results: 21 patients (2.7%) developed IPFI after chemotherapy, including 5 case, 7 cases, 8 cases and 1 case considered as proven, probable, possible and undetermined, respectively. The average age was 60 years old and 77.8% were male. Candida albicans were the most common fungal pathogens. The CT imaging findings were complicated and diverse, in which the double lungs involvement, nodular shadows and crumb of high-density shadows were common. 18 cases relieved after first-line antifungal therapy and the total effective rate was 90.4%. The mortality of patients with primary end-stage disease and bacterial infection is high, and the prognosis is very poor. Conclusion: Lymphoma patients with fungal infection during chemotherapy lack typical clinical manifestations. The pathogens were difficult to be detected by routine etiology examination and G/GM test combined with lung CT examination are helpful for early diagnosis. Early empirical antifungal therapy can improve prognosis. |
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