儿童侵袭性肺部真菌感染195例临床分析

doi:10.12372/jcp.2023.22e0925

摘要/Abstract

摘要：

目的分析侵袭性肺部真菌感染（IPFI）患儿的临床资料，为儿童IPFI的早期识别和诊断提供帮助。方法回顾性分析195例IPFI患儿的临床资料。结果 195例患儿中男123例、女72例；中位年龄9.5（0.9~62.0）月，新生儿（<28 d）52例，婴幼儿（28 d~3岁）79例，年长儿（3~18岁）64例。新生儿基础疾病以早产儿居多（75.0%），婴幼儿免疫缺陷病较多（20.3%），年长儿血液系统疾病较多（31.3%）。不同年龄组间两联抗生素使用、血液净化或透析、留置胃管、使用糖皮质激素、化疗或其他免疫抑制剂治疗、胃肠外营养的比例差异有统计学意义（P<0.05）。病原菌以白色假丝酵母菌为主（69.2%），不同年龄组间白色假丝酵母菌、热带假丝酵母菌和曲霉菌的比例差异有统计学意义（P<0.05）。念珠菌对唑类抗真菌药耐药率较高，对两性霉素B和5-氟胞嘧啶耐药率较低。结论儿童侵袭性肺部真菌感染以婴幼儿居多，不同年龄段基础疾病及侵袭性因素有差异，病原菌以念珠菌居多，菌种分布可能与年龄有关，念珠菌对唑类耐药率较高。

关键词: 侵袭性肺部真菌感染, 病原菌, 儿童

Abstract:

Objective To analyze the clinical data of 195 children with invasive pulmonary fungal infection (IPFI), and to provide help for early identification and diagnosis of IPFI in children. Methods The clinical data of 195 children with IPFI were retrospectively analysed. Results Among the 195 cases, 123 were male and 72 were female, the median age was 9.5 (0.9-62.0) months. 52 were neonates (<28 d), 79 were infants (28 d-3 years), and 64 were elder children (3-18 years). The most common diseases of newborn were premature infants (75.0%), the most common diseases of infant were immunodeficiency (20.3%), and haematological diseases were more common in elder children (31.3%). The differences in the proportions of two-combination antibiotic use, haemodialysis or dialysis, indwelling gastric tube, use of glucocorticoids, chemotherapy or other immunosuppressive treatments, and parenteral nutrition were statistically significant between different age groups (P<0.05). The main pathogen was Candida albicans (69.2%), and there were significant differences in the proportion of Candida albicans, Candida tropicalis and Aspergillus among different age groups (P<0.05). Candida had a high resistance to azoles and a low resistance to amphotericin B and 5-fluorocytosine. Conclusions Invasive pulmonary fungal infections in children were predominant in infants and young children, with differences in the underlying disease and invasiveness factors in different age groups, with Candida being the predominant pathogen, and the distribution of strains of the organisms may be related to age, with a high rate of resistance to azoles inCandida.

Key words: invasive pulmonary fungal infection, pathogens, child

徐贝雪, 刘泉波. 儿童侵袭性肺部真菌感染195例临床分析[J]. 临床儿科杂志, 2023, 41(8): 584-588.

XU Beixue, LIU Quanbo. Clinical analysis of 195 children with invasive pulmonary fungal infection[J]. Journal of Clinical Pediatrics, 2023, 41(8): 584-588.

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参考文献 20

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基础疾病	新生儿组(n=52)	婴幼儿组(n=79)	年长儿组(n=64)	χ²值	P
心血管系统	16(30.8)	12(15.2)	6(9.4)	9.59	0.008
免疫缺陷病	3(5.8)	16(20.3)	7(10.9)	6.17	0.050
血液系统	0(0)	9(11.4)	20(31.3)	23.40	<0.001
神经系统	0(0)	6(7.6)	8(12.5)	-	0.020¹⁾
消化系统	0(0)	6(7.6)	4(6.3)	4.34	0.123

侵袭性因素	新生儿组(n=52)	婴幼儿组(n=79)	年长儿组(n=64)	χ²值	P
头孢类抗生素	36(69.2)	46(58.2)	39(60.9)	1.66	0.432
碳青霉烯类抗生素	38(73.1)	54(68.4)	41(64.1)	1.08	0.586
β-内酰胺酶抑制剂抗生素	37(71.2)	47(59.5)	36(56.3)	2.93	0.234
糖肽类抗生素	22(42.3)	18(22.8)	19(29.7)	5.68	0.057
上述抗生素两联使用	33(63.5)	32(40.5)	22(34.4)	10.73	0.005
深静脉置管	28(53.8)	29(36.7)	23(35.9)	4.83	0.093
有创机械通气	32(61.5)	40(50.6)	32(50.0)	1.92	0.393
血液净化或透析	1(1.9)	4(5.1)	15(23.4)	-	<0.001¹⁾
胸腔穿刺	6(11.5)	11(13.9)	9(14.1)	0.20	0.929
留置胃管	42(80.8)	42(53.2)	34(53.1)	12.18	0.002
糖皮质激素	2(3.8)	32(40.5)	32(50.0)	29.93	<0.001
化疗或其他免疫抑制剂	0(0)	10(12.7)	23(35.9)	-	<0.001¹⁾
胃肠外营养	48(92.3)	22(27.8)	16(25.0)	66.96	<0.001

病原菌	新生儿(n=52)	婴幼儿(n=79)	年长儿(n=64)	χ²值	P
白色假丝酵母菌	45(86.5)	47(59.5)	43(67.2)	10.95	0.004
近平滑假丝酵母菌	2(3.8)	8(10.1)	2(3.1)	-	0.241¹⁾
热带假丝酵母菌	0	7(8.9)	7(10.9)	-	0.026¹⁾
光滑球拟酵母菌	2(3.8)	2(2.5)	4(6.3)	-	0.540¹⁾
曲霉菌	0	7(8.9)	2(3.1)	-	0.042¹⁾

念珠菌	株数	5-氟胞嘧啶		两性霉素B		氟康唑			伊曲康唑			伏立康唑
念珠菌	株数	S	R	S	R	S	Ⅰ	R	S	Ⅰ	R	S	Ⅰ	R
白色假丝酵母菌	208	202(97.1)	6(2.9)	208(100)	0(0)	188(90.4)	7(3.4)	13(6.2)	180(86.5)	13(6.3)	14(6.7)	191(91.8)	3(1.4)	14(6.7)
近平滑假丝酵母菌	16	16(100)	0(0)	16(100)	0(0)	13(81.3)	3(18.8)	0(0)	15(93.8)	1(6.3)	0(0)	15(93.8)	1(6.3)	0(0)
热带假丝酵母菌	22	22(100)	0(0)	22(100)	0(0)	21(95.5)	0(0)	1(4.5)	18(81.8)	3(13.6)	1(4.5)	19(86.4)	1(4.5)	2(9.1)
光滑球拟酵母菌	11	11(100)	0(0)	11(100)	0(0)	1(9.1)	10(90.9)	0(0)	1(9.1)	10(90.9)	0(0)	9(81.8)	2(18.2)	0(0)
葡萄牙假丝酵母菌	3	3(100)	0(0)	0(0)	3(100)	3(100)	0(0)	0(0)	3(100 )	0(0)	0(0)	3(100)	0(0)	0(0)
季也蒙假丝酵母菌	1	1(100)	0(0)	1(100)	0(0)	0(0)	1(100)	0(0)	0(0)	1(100)	0(0)	-	-	-
挪威假丝酵母菌	2	0(0)	2(100)	1(50)	1(50)	1(50)	1(50)	0(0)	0(0)	2(100)	0(0)	2(100)	0(0)	0(0)
产朊假丝酵母菌	1	1(100)	0(0)	1(100)	0(0)	1(100)	0(0)	0(0)	1(100)	0(0)	0(0)	1(100)	0(0)	0(0)