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目的 报道 1例急性髓系白血病 (AML) M2a患者化疗后骨髓抑制期发生侵袭性鼻脑曲霉菌病 (invasiverhinocerebralaspergillosis,IRA)及其治疗经过 ,并进行文献复习。方法 1例AML M2a患者 ,化疗后骨髓抑制期发生IRA ,连续给予两性霉素B(AmB) ,包括脂质体AmB治疗 ,同时给予大蒜素、5 氟胞嘧啶 (5 FC)、氟康唑、伊曲康唑、酮康唑、益康唑及制霉菌素等联合治疗 ,并先后 2次行开颅病灶切除、减压术。结果 经过上述治疗 ,患者生存时间虽略有延长 ,但最终仍因感染无法彻底控制而死亡。结论 对于大部分IRA目前尚无特效治疗措施 ,AmB也仅对少部分患者有效 ,结合手术切除病灶是目前为止最佳的治疗方法。
Objective To report the occurrence of invasive hinocerebral aspergillosis (IRA) and its treatment in a patient with acute myeloid leukemia (AML) M2a after bone marrow suppression after chemotherapy, and to review the literature. METHODS: One case of AML M2a was treated with IRA after bone marrow suppression after chemotherapy. Amphotericin B (AmB) was continuously administered, including liposomal AmB treatment, and allicin, 5-fluorocytosine (5 FC), and fluconazole were given simultaneously. Itraconazole, ketoconazole, econazole, and nystatin were used in combination therapy, and 2 cases of open heart resection and decompression were performed. Results After the above treatment, the patient’s survival time was slightly prolonged, but it eventually died due to incomplete control of the infection. Conclusion For most IRAs, there are currently no specific treatment measures. AmB is only effective for a small number of patients. Combining surgical resection lesions is by far the best treatment.