作者单位： 510120 广州，中山大学孙逸仙纪念医院儿科

    儿童系统性红斑狼疮合并侵袭性肺真菌病二例

    欧榕琼檀卫平董红

    【摘要】SLE是一种多系统受累的慢性自身免疫性疾病，儿童SLE发病过程较成人更凶险，累及各个脏器的几率更高，因而需要使用更高强度的免疫抑制剂。由于自身的免疫功能受损以及免疫抑制剂的使用，侵袭性真菌病(IFD) 尤其是侵袭性肺真菌病(IPFD) 成为儿童SLE治疗过程中的突出问题。该文分析了2例SLE合并IPFD患儿的临床资料，2例患儿均符合2009 SLE国际合作组(SLICC)诊断标准，主要临床表现有发热、咳嗽、气促等，依据痰培养、血浆1,3-β-D- 葡聚糖(G试验)和肺部CT临床诊断侵袭性肺真菌病，诊断后均在积极治疗SLE的基础上予经验性抗真菌治疗，治疗后IPFD均治愈。该2例的诊治经过提示，儿童SLE易合并IPFD，临床可依据真菌培养、G试验、肺部CT等协助诊断，一旦临床诊断，应早期予经验性或抢救性抗真菌治疗，同时积极控制SLE活动，从而提高危重患儿救治成功率。充足的抗真菌疗程是减少感染复发的保证。

    【关键词】儿童；系统性红斑狼疮；侵袭性肺真菌病；抗真菌治疗

    DOI：10.3969/g.issn.0253-9802.2015.03.015

    通讯作者，檀卫平

    收稿日期：(2014-11-15)

    Childhood-onset systemic lupus erythematosus complicated with invasive pulmonary fungal disease: two case reportsOuRongqiong,TanWeiping,DongHong.DepartmentofPaediatrics,SunYat-senMemorialHospitalofSunYat-senUniversity,Guangzhou510120,China

    Correspondingauthor,TanWeiping

    Abstract【】Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involvement with multiple systems. Childhood-onset SLE (cSLE) is more aggressive than adult counterparts and has a higher incidence of involvement with major organs, which should be administered with more potent immunosuppressants. Invasive fungal disease (IFD), especially invasive pulmonary fungal disease (IPFD), becomes one of the major causes of mortality during the treatment of cSLE due to autoimmune functional defects and use of immunosuppressants. In this report, the clinical features of two children diagnosed as cSLE complicated with IPFD based upon the 2009 SLICC classification criteria for SLE were retrospectively studied and related literatures were reviewed. Main clinical manifestations included fever, cough and tachypnea, etc. Both patients were clinically diagnosed with IPFD based on sputum culture, G test and pulmonary CT. The symptoms of IPFD were alleviated by active SLE treatment combined with empirical antifungal therapy. The diagnosis and treatment of these two cases prompted that SLE is likely to be complicated with IPFD. The diagnosis could be confirmed by sputum culture, G test and pulmonary CT, etc. After the diagnosis is confirmed, empirical or emergent antifungal therapy should be delivered as early as possible. Active measures should be taken to control the activity of SLE, thereby enhancing the success rate of rescuing severe cases. A sufficient course of antifungal treatment could reduce the recurrence rate of fungal infection. ......