儿童急性淋巴细胞白血病化疗后合并肺部感染的临床特征

Clinical features of children with acute lymphoblastic leukemia complicated by pulmonary infection after chemotherapy

摘要:

目的 分析化疗后合并肺部感染的急性淋巴细胞白血病（ALL）患儿的临床特征，为ALL合并肺部感染的早期诊断提供依据。方法 对115例次化疗后合并肺部感染且行肺部CT的ALL患儿（108例）进行回顾性分析，收集患者一般临床资料及肺部螺旋CT结果，探究肺部感染发生的危险因素，以及病原体与肺部CT的影像学特点。结果 儿童ALL化疗后的肺部感染77.4%发生于诱导缓解阶段，多发生于化疗后的31~60 d，以粒缺患儿所占比例（67.0%）最高。病原学拟诊或确诊的41例肺部感染患儿以细菌感染（36%）与真菌感染（41%）的发生率较高。细菌或真菌感染所致肺部病变CT表现的差异无统计学意义（P > 0.05）。结论 ALL患儿在化疗诱导缓解阶段，尤其是粒细胞缺乏时肺部感染发生率高。细菌和/或真菌是主要病原体，难以根据肺部影像学改变明确肺部感染的性质。

Abstract:

Objective To examine the clinical features of children with acute lymphoblastic leukemia (ALL) complicated by pulmonary infection after chemotherapy. Methods The clinical data of 108 ALL children (115 case-times) with post-chemotherapy pulmonary infection were retrospectively reviewed. The risk factors for pulmonary infection and the relationship between pathogens and chest CT findings were evaluated. Results The highest incidence (77.4%) of pulmonary infection occurred during remission induction, peaking at 31-60 days after chemotherapy. Patients with neutropenia had the highest incidence rate of pulmonary infection (67.0%). Bacteria (36%) and fungi (41%) were the two most common pathogens in the 41 patients who were etiologically suspected of or diagnosed with pulmonary infection. There was no significant difference in chest CT findings between patients with bacterial and fungal infections. Conclusions The children with ALL are most susceptible to pulmonary infection during remission induction, especially when they are neutropenic. Bacteria and fungi are the main pathogens of pulmonary infections in these patients. However, the changes in chest CT images are poor indicators of the nature of pulmonary infection.