儿童恶性血液病合并侵袭性真菌病的诊断和治疗进展

摘要

近年来由于强烈有效的化学治疗和造血干细胞移植，恶性血液病患儿的长期存活率已明显提高。化学治疗容易合并侵袭性真菌病（IFD），但目前 IFD 的诊断和治疗均存在局限性，因此恶性血液病合并 IFD 的发病率和病死率呈显著增加的趋势，其诊治问题已成为临床医师面临的重大挑战之一。该文就儿童恶性血液病合并 IFD 的诊断和治疗作一介绍，IFD 的诊断方面主要介绍了病原菌的形态学检查、血清学检测、分子生物学检测、病理活组织检查及相关的影像学检查；IFD 的治疗方面主要介绍了预防性治疗、经验性治疗、诊断驱动治疗和目标治疗，而对于难治或高危患儿，目前常采用免疫治疗。%Recently,the long-term survival rate of children with hematologic malignancies has been significantly improved due to the intense and effective chemotherapy and hematopoietic stem cell transplanta-tion.The children with hematological malignancies undergoing chemotherapy are susceptible to suffering from invasive fungal diseases (IFD).However,the diagnosis and treatment of IFD have certain limitations.Hence, the incidence and mortality of hematologic malignancies complicated with IFD have been dramatically in-creased,which is becoming one of the challenging issues to clinicians.In this paper,the diagnosis and treat-ment of hematologic malignancies complicated with IFD in children were reviewed.The diagnosis of IFD includ-ed evaluation of pathogen morphology,serological and molecular biological detection,histopathological exami-nation and relevant imaging analysis.The treatment of IFD mainly consisted of preventive-,empirical-,diagno-sis-driven-and targeted-therapy.Adjuvant immunotherapy is widely employed for children with refractory or high-risk hematologic malignancies.