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[血液病患者肝脾念珠菌病的临床特征与预后]

[Clinical features and prognosis of hepatosplenic candidiasis in patients with hematopathy].

作者信息

Zhu D P, Ma R, He Y, Luo X Y, Han W, Li C, Zhou J R, Liao Y, Tang B R, Longka Q L T, Huang X J, Sun Y Q

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2024 Jul 14;45(7):683-688. doi: 10.3760/cma.j.cn121090-20231230-00347.

Abstract

Hepatosplenic candidiasis (HSC) is a rare type of candidiasis that can occur in patients with hematologic malignancies, hematopoietic stem cell transplantation. At present, there is still a lack of studies on HSC in patients with hematologic disorders. Based on The Chinese Guidelines for the Diagnosis and Treatment of Invasive Fungal Disease in Patients with Hematological Disorders and Cancers (the 6th revision), We retrospectively analyzed the clinical characteristics and prognosis of patients with HSC treated in Peking University Institute of Hematology from 2008 to 2022. Finally, eighteen patients were included, with 1 (5.6%) proven, 2 (11.1%) probable, and 15 (83.3%) possible HSC. Among them, 3 (16.7%) patients occurred after haploid hematopoietic stem cell transplantation and 15 (83.3%) patients occurred after chemotherapy. 6 (33.3%) patients had positive blood cultures, including 4 cases of Candida tropicalis and 2 cases of Candida albicans. At 4 weeks of antifungal therapy, 10 (58.8%) patients achieved partial response (PR), At 8 weeks, 1 (6.3%) patients achieved complete response and 10 (62.5%) patients achieved PR. At 6 months after diagnosis, 3 (16.7%) patients died of hematopoietic recurrence, and none of them died of HSC. As a rare fungal infection disease, HSC has a low positive rate of microbiological and histological examinations, a persistent treat cycle, and has difficulty in remission, reminding us of the need for vigilance in patients with hematopoietic disorders and persistent fever.

摘要

肝脾念珠菌病(HSC)是一种罕见的念珠菌病,可发生于血液系统恶性肿瘤、造血干细胞移植患者。目前,针对血液系统疾病患者的HSC研究仍较为缺乏。基于《血液病及恶性肿瘤患者侵袭性真菌病诊断和治疗中国指南(第6版)》,我们回顾性分析了2008年至2022年在北京大学血液病研究所接受治疗的HSC患者的临床特征及预后。最终纳入18例患者,其中确诊1例(5.6%),拟诊2例(11.1%),可能诊断15例(83.3%)。其中,3例(16.7%)患者发生于单倍体造血干细胞移植后,15例(83.3%)患者发生于化疗后。6例(33.3%)患者血培养阳性,其中热带念珠菌4例,白色念珠菌2例。抗真菌治疗4周时,10例(58.8%)患者达到部分缓解(PR);8周时,1例(6.3%)患者达到完全缓解,10例(62.5%)患者达到PR。诊断后6个月,3例(16.7%)患者死于造血系统复发,均非死于HSC。作为一种罕见的真菌感染性疾病,HSC微生物学及组织学检查阳性率低,治疗周期长,缓解困难,提示我们对血液系统疾病伴持续发热患者需保持警惕。

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