| 摘要: |
| 目的:探讨儿童侵袭性肺部真菌感染(IPFI)的临床特点,以提高临床医师对IPFI 的认识,为有效防治IPFI 提供参考。方
法:回顾性分析我院2015 年1 月至2020 年6 月确诊、临床诊断、拟诊的89 例IPFI 患儿临床特征、治疗及预后等情况。结果:89
例IPFI 患儿中,男57 例,女32 例,中位年龄6. 5 岁。其中,79 例患儿有基础疾病,以血液系统恶性肿瘤为主;10 例无基础疾病
患儿的宿主因素主要为重症腺病毒感染病史、诊断前抗菌药物使用时间>10 d、住院期间接受侵入性操作。临床表现以高热、咳
嗽、咳痰为主。常见胸部CT 表现:肺炎样表现75 例(84. 3%)、结节影34 例(38. 2%)、空气支气管征29 例(32. 6%)。所有患儿
均接受抗真菌药物治疗,86. 5%治疗有效,抗真菌药物以伏立康唑为主。73 例有反复发热,加用抗真菌药物后64 例(87. 7%)体
温稳定。患儿抗真菌治疗前中性粒细胞缺乏时间与住院抗真菌治疗时间呈正相关(r =0. 519,P<0. 01)。结论:有基础疾病的患
儿是IPFI 好发人群,对于无基础疾病患儿抗菌药物的长期使用、重症感染及接受侵入性操作是主要危险因素。儿童IPFI 确诊
率较低,对于反复发热且伴有粒细胞缺乏的高危患儿,应警惕真菌感染,尽早行相关实验室及影像学检查,早诊断、早治疗可以
提高抗真菌治疗效果,缩短住院时间。 |
| 关键词: 儿童 侵袭性真菌感染 肺部 临床特征 治疗 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2023.04.010 |
|
| 基金项目: |
|
| Clinical Characteristics Analysis of 89 Children with Invasive Pulmonary Fungal Infection |
| Liao Juan, Tan Jianrong, Peng Donghong |
| ((Children’s Hospital of Chongqing Medical University, Ministry of Education Key
Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing
400014, China)) |
| Abstract: |
| Objective: To explore the clinical characteristics of invasive pulmonary fungal infections (IPFI) in children, in order to
improve the understanding of the disease and provide the basis for effective prevention and treatment of IPFI. Methods: A retrospective
analysis was conducted on the clinical features, treatment, and outcomes of 89 children with IPFI, who were diagnosed, clinically
diagnosed, and presumed to be diagnosed from January 2015 to June 2020 in our hospital. Results: Among the 89 cases of children with
IPFI, 57 were male, and 32 were female, with the median age of 6. 5 years. Among all the children, 79 had underlying diseases,
mainly hematologic malignancies. The host factors of the 10 patients without underlying disease were a history of severe adenovirus
infection, antibiotic use for more than 10 days before diagnosis, and invasive procedures during hospitalization. The main clinical
manifestations were high fever, cough, and sputum. The common chest CT findings were as follows: pneumonia-like manifestations in 75
cases (84. 3%), nodular shadow in 34 cases (38. 2%), and air bronchial sign in 29 cases (32. 6%). All children had antifungal
therapy, with effective treatment rate of 86. 5%, and voriconazole was the main choice of antifungal drugs. Among all the children, 73
patients had recurrent fever, and the temperature of 64 patients (87. 7%) stabilized after the addition of antifungal drugs. Before
antifungal therapy in children with neutrophils to lack of time and corresponding hospital antifungal treatment time were positively
correlated (r =0. 519, P<0. 01). Conclusion: Children with underlying diseases are the most favorite population for IPFI, while longterm
use of antibiotics, severe infection and receiving invasive procedures are the main risk factors for children without underlying
diseases. The diagnostic rate of IPFI in children is relatively low. For children at high risk with recurrent fever and agranulocytosis, it is
necessary to be alert to fungal infection, conduct relevant laboratory and imaging examinations as early as possible, and make early
diagnosis to improve the effect of antifungal therapy and reduce the length of hospital stay. |
| Key words: children invasive fungal infection lung clinical characteristic treatment |
