孙艳　黄俊霞　高燕　李田兰　刘珊珊　孟繁军

[摘要]目的 探讨急性白血病病人医院内感染热带假丝酵母菌性败血症的临床特点及危险因素。方法回顾分析2016年1月—2019年1月我院收治、经血培养证实为急性白血病合并热带假丝酵母菌性败血症10例病人的临床资料。结果 10例病人血培养证实为热带假丝酵母菌感染。10例病人均有高热，伴寒颤5例，合并细菌性败血症2例，3例病人痰液培养出多重耐药菌;肺部症状10例;皮肤软组织感染2例;1例病人虽拔除静脉导管但仍然死亡;棘白菌素抗真菌治疗总有效率为40%。死亡6例，1例死于感染性休克，4例死于重症肺炎、呼吸衰竭，1例死于心力衰竭;发生感染至死亡时间为1～18 d。结论 急性白血病医院感染热带假丝酵母菌性败血症临床表现不典型，病死率较高，治疗首选棘白菌素类。

[关键词] 白血病;热带念珠菌;真菌血症;危险因素

[中图分类号] R733.7[文献标志码] A[文章编号] 2096-5532（2020）04-0464-05

doi：10.11712/jms.2096-5532.2020.56.081

[网络出版] http：//kns.cnki.net/kcms/detail/37.1517.R.20200417.1000.016.html;2020-04-17 17：26

CLINICAL FEATURES OF ADULT ACUTE LEUKEMIA WITH CANDIDA TROPICALIS SEPSIS

SUN Yan， HUANG Junxia， GAO Yan， LI Tianlan， LIU Shanshan， MENG Fanjun

（Department of Hematology， Affiliated Hospital of Qingdao University， Qingdao 266003， China）

[ABSTRACT]Objective To investigate the clinical features and risk factors for nosocomial infection with Candida tropicalis sepsis in patients with acute leukemia. Methods A retrospective analysis was performed on the clinical data of 10 cases of acute leukemia with C. tropicalis sepsis confirmed by blood culture admitted to our hospital from January 2016 to January 2019. [WTHX]Results All of the ten patients were confirmed infected with C. tropicalis according to blood culture results. All ten patients had high fever （100%）， of whom five were with shaking chills （50%）， two were with bacterial sepsis （20%）， and three had multidrug-resistant organisms in their sputum culture （30%）; ten patients had pulmonary symptoms; two patients had skin and soft tissue infections. One case died after extubation. The echinocandin antifungal therapy had an overall response rate of 40% （4/10）. Six cases died， of which one died of septic shock， four died of severe pneumonia and respiratory failure， and one died of heart failure; the time from infection to death ranged from 1 to 18 d. Conclusion Nosocomial infection with C. tropicalis sepsis in cases of acute leukemia has atypical clinical manifestations and a high mortality rate. Echinocandins are preferred for the treatment.

[KEY WORDS] leukemia; Candida tropicalis; fungemia; risk factors

侵袭性真菌病是因真菌侵入人体，在组织、器官或血液中生长和繁殖，引起炎症反应和组织损伤而且威胁生命的感染性疾病。侵袭性真菌病经常发生于密集化疗后（诱导和巩固）的急性非淋巴细胞白血病（AML）病人中[1-3]。侵袭性真菌病的发生导致这些病人的死亡率显著增加[2，4]。临床实践中血培养真菌阳性的比例并不高，其中经鉴定为热带假丝酵母菌更为少见。本文回顾性分析我院血液科近3年收治10例急性白血病合并热带假丝酵母菌性败血症病人的临床资料，并结合文献复习，探讨急性白血病合并热带假丝酵母菌性败血症的临床特点、影响因素，以指导其临床诊治。……