摘要目的 探讨急性白血病患儿化疗后并发侵袭性真菌感染(IFI)的危险因素.方法 收集2005年1月至2017年2月广州市妇女儿童医疗中心住院治疗的急性白血病患儿的病例资料,其中96例并发IFI患儿作为研究组,随机选取同期住院未发生IFI感染的急性白血病患儿96例作为对照组.回顾性分析合并IFI感染患儿的临床特征,采用多因素Logistic回归分析对急性白血病并发IFI感染的可能危险因素进行分析.结果 96例IFI患儿中,痰液、支气管肺泡灌洗液或血液中培养出真菌78例,其中以口腔(42例,43.75％)和肺部(36例,37.50％)感染为主;检出最多的为白假丝酵母菌,有26例(26/78,33.33％),其次为近平滑假丝酵母菌(16例,20.51％)和热带假丝酵母菌(16例,20.51％).单因素分析发现,含有激素的化疗方案、粒细胞缺乏(＜0.5×109/L)、粒细胞缺乏＞10 d、使用碳青霉烯类抗菌药物和抗菌药物使用≥2种与IFI感染有关(P＜0.05或＜0.01);多因素Logistic回归分析发现,粒细胞缺乏＞l0d(OR=11.390, 95％CI4.145～55.263,P ＜0.01)、使用碳青霉烯类药物(OR =4.825, 95％CIl.681～ 13.842,P＜0.01)和使用含有激素类的化疗方案(OR=2.220,95％CIl.542 ～ 8.246,P＜0.05)是急性白血病患儿并发IFI感染的危险因素.结论 临床上合理使用抗菌药物和激素,同时采取及时有效的措施恢复粒细胞计数,有助于降低急性白血病患儿并发IFI感染的发生率.

abstractsObjective To analyze the clinical features and risk factors of invasive fungal infections (IFI) in children with acute leukemia.Methods Ninety-six acute leukemia children complicated with IFI admitted in Guangzhou Women and Children's Medical Center during January 2005 and February 2017 were retrospectively reviewed, and 96 cases of acute leukemia without IFI admitted at the same period were randomly selected as control group.The clinical manifestations of IFI were analyzed, multivariate Logistic regression was used to study risk factors of the complication of IFI in pediatric acute leukemia.Results Among 96 children complicated with IFI, fungus were detected in samples from sputum, bronchoalveolar lavage fluid, or blood in 78 cases, in which 42 cases (43.75％) were oral infection, 36 cases (37.50％) were pulmonary infection.Candida albicans (33.33％, 26/78) was the most commonly isolated pathogen, followed by Candida parapsilosis (20.51％, 16/78) and Candida tropicalis (20.51％, 16/78).Univariate analysis revealed hormone-containing chemotherapy, neutropenia (＜ 0.5 × 109/L), time duration of neutropenia ≥ 10 days, usage of carbapenem antibiotics and combined drug administration ≥2 types were associated with fungal infection (P ＜ 0.05 or ＜0.01).Multivariate Logistic regression showed that the time duration of neutropenia ≥ 10 days (OR =11.390, 95％ CI 4.145-55.263, P ＜ 0.01),usage of carbapenem antibiotics (OR =4.825, 95％ CI 1.681-13.842, P ＜ 0.01) and hormone-containing chemotherapy (OR =2.220, 95％ CI 1.542-8.246, P ＜ 0.05) were the independent risk factors of IFI.Conclusion Rational usage of antibiotics and effective measures taken to restore the granulocytes can help to reduce the incidence of IFI in children with acute leukemia.