1例两性霉素B脂质体联合泊沙康唑治疗儿童糖尿病合并肺毛霉菌病并文献复习

EfficacyandsafetyofliposomalamphotericinBcombinedwithposaconazoleintreatmentofdiabetesmellituswithpulmonarymucormycosisinchildren：acasereportandliteraturereview

摘要:

目的：探索两性霉素B脂质体联合泊沙康唑治疗儿童糖尿病合并肺毛霉菌病的有效性和安全性。方法：回顾性分析1例儿童糖尿病合并肺毛霉菌病患者应用两性霉素B脂质体联合泊沙康唑治疗过程并文献复习。结果：支气管镜下发现左肺上叶段支气管痰栓堵塞和肉芽增生，支气管肺泡灌洗液涂片见毛霉菌，诊断肺毛霉菌病。予两性霉素B脂质体静脉治疗1周后复查胸部CT发现左上肺空洞样改变，加用泊沙康唑口服。两性霉素B治疗3周时患者出现窦性心动过缓伴室性早搏，停两性霉素B脂质体后好转。改为泊沙康唑序贯治疗至12周，患者左上肺空洞消失且未出现不良反应。结论：儿童糖尿病合并肺毛霉菌病少见且治疗困难，两性霉素B脂质体联合泊沙康唑治疗方案为临床治疗提供诊疗经验。

Abstract:

Objective：ToexploretheefficacyandsafetyofliposomalamphotericinBcombinedwithposaconazoleinthetreatmentofdiabetesmellituswithpulmonarymucormycosisinchildren.Methods：AretrospectiveanalysiswasperformedonthetreatmentofachildwithdiabetesmellitusandpulmonarymucormycosisbyliposomalamphotericinBcombinedwithposaconazole，andtherelevantliteraturewasreviewed.Results：Sputumboltocclusionandgranulomatoushyperplasiawerefoundinthesegmentalbronchioftheleftupperlobe，andmucoraleswerefoundinbronchoalveolarlavagefluid，soadiagnosisofpulmonarymucormycosiswasmade.Afterin－travenousadministrationofliposomalamphotericinBfor1week，achestCTre-examinationrevealedcavity-likechangesintheleftupperlung，andoralposaconazolewasadded.At3weeksofadministrationofliposomalamphotericinB，thepatientdevelopedsinusbradycardiawithprematureventricularbeats，whichimprovedafterdiscontinuationofliposomalamphotericinB.Themedicationwaschangedtosequentialadministrationofposaconazoleuptothe12thweek，andthecavitiesintheleftupperlungdisappearedwithoutanyadversereactionobserved.Conclusions：Diabetesmellituswithpulmonarymucormycosisinchildrenarerareanddifficulttotreat.TheregimenofliposomalamphotericinBcombinedwithposaconazoleprovidessomereferencefortheclinicaldiagnosisandtreatmentofthecondition.