血液病合并鼻眶脑毛霉菌感染15例临床分析
Clinical analysis of 15 cases of hematologic diseases complicated with rhino-orbito-cerebral mucormycosis

达海丽.血液病合并鼻眶脑毛霉菌感染15例临床分析[J].内科急危重症杂志,2026,32(2):136-140

DOI：10.11768/nkjwzzzz20260207

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作者	单位	E-mail
达海丽		tianweiwei@sxbqeh.com.cn

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中文摘要:

摘要目的：探讨血液病患者合并鼻眶脑毛霉菌感染的临床特征、诊断、治疗及预后。方法：回顾性分析多中心收治的15例血液病合并鼻眶脑毛霉菌感染患者的临床资料，对其人口学特征、原发病、临床表现、影像学特征、病原学结果、治疗方案及转归进行分析。结果：15例患者中，男11例，女4例，中位年龄59（19～77）岁。原发病包括再生障碍性贫血6例，急性髓系白血病4例，骨髓增生异常肿瘤3例，原发中枢淋巴瘤1例，T淋巴母细胞淋巴瘤1例。病原学以根霉属最常见（7例，其中小孢根霉5例）。临床主要表现面部肿胀疼痛（46.67%）及眶周肿胀或眼睑下垂（46.67%）。12例患者接受两性霉素B（包括脂质体及胆固醇硫酸酯复合物）单药或联合药物治疗，3例接受泊沙康唑或艾沙康唑单药治疗。死亡9例（60%），且均在确诊后3周内死亡。6例（40%）治愈，其中2例接受了联合手术治疗。结论：血液病合并鼻眶脑毛霉菌感染病情凶险、进展迅速、病死率高。治疗关键在于早期应用抗毛霉菌药物，并积极联合手术清创，有望改善患者预后。

英文摘要:

Abstract Objective: To investigate the clinical characteristics, diagnosis, treatment, and prognosis of hematologic diseases complicated by rhino-orbito-cerebral mucormycosis. Methods: A multicenter retrospective analysis was conducted on clinical data from 15 patients with hematologic diseases complicated by rhino-orbito-cerebral mucormycosis. Demographic characteristics, primary diseases, clinical manifestations, imaging features, etiological results, treatment regimens, and outcomes were analyzed. Results: Among the 15 patients, there were 11 males and 4 females, with a median age of 59 years (range, 19-77 years). The primary diseases included aplastic anemia (6 cases), acute myeloid leukemia (4 cases), myelodysplastic neoplasms (3 cases), primary central nervous system lymphoma (1 case), and T-lymphoblastic lymphoma (1 case). The most common pathogen was Rhizopus species (7 cases, including Rhizopus microsporus in 5 cases). The main clinical manifestations were facial swelling and pain (46.67%) and periorbital swelling or ptosis (46.67%). Twelve patients received amphotericin B (including liposomal and cholesterol sulfate complex formulations) as monotherapy or combination therapy, 3 patients received isavuconazole or posaconazole monotherapy. Nine patients (60%) died, all within 3 weeks after diagnosis. Six patients (40%) achieved cure, of whom 2 received combined surgical treatment. Conclusion: Hematologic diseases complicated by rhino-orbito-cerebral mucormycosis are associated with a fulminant clinical course, rapid progression, and high mortality. The key to improving prognosis lies in early administration of antifungal agents active against mucormycetes and active combined surgical debridement.