急性白血病合并侵袭性曲霉病的临床治疗

目的:探讨急性白血病合并侵袭性曲霉病患儿抗真菌治疗和连续强烈化疗的治疗经验。方法:回顾分析我院2007年7月至2008年7月收治的4例儿童急性白血病合并侵袭性曲霉病的诊断和治疗。结果:3例急性淋巴细胞白血病（ALL）诱导缓解化疗和1例急性髓细胞白血病(AML)巩固化疗的患儿合并侵袭性曲霉病，1例确诊，3例拟诊，诊断时CT表现均有晕轮征。抗霉菌初始用药首选伏立康唑或两性霉素B。治疗2~5周病灶好转，4月至1年病灶缓解。4例按计划继续强烈化疗，霉菌感染至继续化疗的平均时间为35 d，无霉菌复发。结论: CT晕轮征可作为早期诊断侵袭性曲霉病的指标；基于晕轮征的抢先治疗和患者免疫功能的逆转可改善侵袭性曲霉病的预后；化疗同时持续抗霉菌治疗是完成连续强烈化疗而无霉菌复发的保障。［中国当代儿科杂志，2009，11（11）：901-904］

Treatment of acute leukemia complicated by invasive aspergillosis in children

OBJECTIVE: To study the antifungal treatment and intensive chemotherapy in children with acute leukemia and invasive aspergillosis. METHODS: The diagnosis and treatment of 4 cases of childhood acute leukemia complicated by invasive aspergillosis between July 2007 and July 2008 were studied retrospectively. RESULTS: Three children who underwent remission induction chemotherapy for ALL and one who underwent consolidation chemotherapy for AML developed invasive aspergillosis. One child with proven aspergillosis and 3 with possible aspergillosis all had halo sign on CT at diagnosis. Voriconazole or amphotericin B was given as primary therapy. Improvements of fungal lesions were shown by CT after two to four weeks of antifungal therapy. Complete radiologic remissions were achieved between 4 months and one year. The intensive chemotherapy schedule was continued in all of 4 cases. The median time from fungal infection to the continuation of chemotherapy was 35 days. None showed recurrence of fungal infection. CONCLUSIONS: The halo sign on CT may be a reliable indicator for the early diagnosis of invasive aspergillosis. The preemptive antifungal therapy on the basis of the identification of a halo sign and the reversal of immunosuppression may improve the outcome of invasive aspergillosis. Prolonged antifungal treatment during subsequent cycles of chemotherapy permits completion of scheduled intensive chemotherapy without fungal recurrence.［Chin J Contemp Pediatr, 2009, 11 (11):901-904］