标准与讨论
ENGLISH ABSTRACT
血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第六次修订版)
中国医师协会血液科医师分会
中国侵袭性真菌感染工作组
作者及单位信息
·
DOI: 10.3760/cma.j.cn112138-20200627-00624
The Chinese guidelines for the diagnosis and treatment of invasive fungal disease in patients with hematological disorders and cancers (the 6th revision)
Chinese Association Hematologists
Chinese Invasive Fungal Infection Working Group
Huang XiaoJun
Authors Info & Affiliations
Chinese Association Hematologists
Chinese Invasive Fungal Infection Working Group
Huang XiaoJun
Department of Hematology, Peking University People′s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
·
DOI: 10.3760/cma.j.cn112138-20200627-00624
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摘要

中国侵袭性真菌感染工作组在2005年首次制定了血液病/恶性肿瘤患者侵袭性真菌病(IFD)的诊断标准及治疗原则,并先后经历多次修订。近年来, 血液肿瘤领域出现了很多新治疗手段(如靶向治疗等),使得IFD的高危人群、IFD的流行病学、IFD诊治策略都发生了一些变化;同时IFD的诊断方法累积了更多的临床研究数据。基于这些变化,中国侵袭性真菌感染工作组经反复讨论,参照欧洲癌症研究和治疗组织-感染性疾病协作组(EORTC-IDG)和美国真菌病研究组(MSG)标准、美国抗感染学会(IDSA)指南及欧洲白血病抗感染委员会(ECIL)指南对我国原有IFD的诊断标准与治疗原则进行了再次修订。本版诊治原则对流行病学部分进行了相应修订;诊断体系上保留了确诊、临床诊断、拟诊及未确定的诊断分层;治疗方面则仍按预防治疗、经验治疗、诊断驱动治疗及目标治疗的策略进行修订;新增体外药敏试验、治疗性药物浓度监测相关内容。

侵袭性真菌病;诊断;治疗;血液病;肿瘤
ABSTRACT

The Chinese Invasive Fungal Infection Working Group published the first edition of guidelines for the diagnosis and treatment of IFD in patients with hematological disorders and cancers in 2005, and has been revised several editions thereafter. Recently, new treatments such as targeted therapy have emerged in the field of hematological cancers. These advances are modifying the definition of high-risk IFD, the epidemiology of IFD, and the strategies in IFD diagnosis and treatment. Meanwhile, diagnostic methods of IFD were evaluated in a lot of clinical studies. Therefore, the Chinese Working Group of Invasive Fungal Infections issued the latest Chinese guideline, based on Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC-IDG) and the American Mycoses Study Group (MSG) standards, the Infectious Diseases Society of America (IDSA) guidelines and the European Conference on Infections in Leukemia (ECIL) guidelines. The IFD is still classified as Proven, Probable, Possible and Undefined; the management strategies include prophylaxis, empirical antifungal therapy, diagnostic-driven antifungal therapy and targeted anti-fungal therapy. The major revisions include the epidemiology of IFD, in vitro susceptibility tests of anti-fungal drugs, and therapeutic drug concentration monitoring.

Invasive fungal disease;Diagnosis;Treatment;Hematological diseases;Cancers
Huang XiaoJun, Department of Hematology, Peking University People′s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing 100044, China;Email: nc.defudabe.umjbnujoaixgnauh
引用本文

中国医师协会血液科医师分会,中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第六次修订版)[J]. 中华内科杂志,2020,59(10):754-763.

DOI:10.3760/cma.j.cn112138-20200627-00624

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侵袭性真菌病(invasive fungal disease,IFD)系指真菌侵入人体,在组织、器官或血液中生长、繁殖,并导致炎症反应及组织损伤的感染性疾病。中国侵袭性真菌感染工作组在2005年首次制定了血液病/恶性肿瘤患者IFD的诊断标准及治疗原则,并先后经历多次修订。自2017年第五次修订以来,血液肿瘤领域出现了很多新治疗手段(如靶向治疗等),同时IFD诊断方法累积了更多的临床研究数据,这些方面对IFD的高危人群、IFD的流行病学、IFD诊治策略都带来了一些变化。基于这些变化,中国侵袭性真菌感染工作组经反复讨论,参照欧洲癌症研究和治疗组织-感染性疾病协作组(EORTC-IDG)和美国真菌病研究组(MSG)标准 1、美国抗感染学会(IDSA)指南 2 , 3 , 4及欧洲白血病抗感染委员会(ECIL) 5 , 6指南对我国原有IFD的诊断标准与治疗原则进行了再次修订 7。本版诊治原则流行病学部分进行了相应修订;诊断体系上保留了确诊(proven)、临床诊断(probable)及拟诊(possible)、未确定(undefined)的诊断分层;治疗方面则仍按预防治疗(antifungal prophylaxis)、经验治疗(empirical antifungal therapy)、诊断驱动治疗(diagnostic-driven antifungal therapy)及目标治疗(targeted antifungal therapy)的策略进行修订;新增体外药敏试验、治疗性药物浓度监测相关内容。
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备注信息
A
黄晓军,北京大学人民医院血液科 北京大学血液病研究所 北京市造血干细胞移植重点实验室 血液系统疾病国家临床医学研究中心100044,Email: nc.defudabe.umjbnujoaixgnauh
B

中国医师协会血液科医师分会, 中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第六次修订版)[J]. 中华内科杂志, 2020, 59(10): 754-763. DOI: 10.3760/cma.j.cn112138-20200627-00624.

C
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