摘要
目的 了解侵袭性真菌病的病原谱、临床特征和易感因素,提高临床医生对真菌感染的认识,为临床早期诊治提供依据.方法 回顾性分析南京医科大学第一附属医院2006 2012年收治的165例非移植侵袭性真菌病患者的临床资料,按照统一标准重新确定诊断级别并分析其科室分布、临床表现、病原谱及易感因素.结果 165例中,男90例,女75例,年龄14 ～ 90岁,平均（54±15）岁.呼吸科病例52例（31.5％）;菌群分布以隐球菌最多（91例,54.9％）,其次为曲霉（52例,31.4％）和毛霉（10例,5.9％）.肺真菌病的临床表现多为咳嗽、咳痰、咯血及发热,影像学表现多样但无特异性,结节或实变影较经典的曲霉球、晕轮征及新月征更为常见.基础疾病前3位依次为糖尿病（26例,15.8％）、慢性阻塞性肺疾病（22例,13.3％）和血液系统恶性肿瘤（17例,10.3％）,66.1％（109例）的患者存在1种或多种高危因素（如联合使用抗生素≥7 d、侵入性操作、长期使用糖皮质激素或免疫抑制剂等）,合并2种及以上高危因素的患者病死率升高.结论 非移植患者侵袭性真菌病前3位病原体分别为隐球菌、曲霉及毛霉,肺和脑是最常见的感染部位;相对于隐球菌感染,曲霉和毛霉感染多存在基础疾病;低蛋白血症和长期使用广谱抗生素是常见的易感因素.
Objective To describe the clinical characteristics of and risk factors for invasive fungal disease,and therefore to improve the early diagnosis and treatment of fungal infections.Methods The clinical data of invasive fungal disease in 165 patients without transplantation from 2006 to 2012 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.The diagnosis was based on the following guidelines：diagnosis and treatment guidelines of critically ill patients with invasive fungal infection（2007）,diagnostic criteria and treatment principle of invasive fungal infection in patients with hematopathy/malignant tumors （fourth edition,2013）,diagnostic criteria and treatment principle of invasive pulmonary fungal infection （draft,2006）.Results Invasive fungal disease was mostly diagnosed in therespiratory department （31.5 ％）.The maj or pathogens were cryptococcus （48.3 ％）,aspergillus （31.7 ％）and followed by mucor （5.9％）.The most common symptoms included cough,haemoptysis,and fever.Radiological Findings were non-specific,nodules or opacities being more common as compared to classical aspergilloma,halo sign,and crescent sign.The most common underlying diseases were diabetes（15.8％）,chronic obstructive pulmonary disease （13.3 ％）,and malignant hematological disease（10.3 ％）.Moreover,66.1％ cases of invasive fungal disease were accompanied by one or more risk factors （eg.administration of antibiotics more than 7 days,invasive operations,and therapy with long-term glucocorticoids or immunosuppressant drugs）.The mortality of invasive fungal disease with more than 2 risk factors was 10.6％.Conclusions The most common pathogens of invasive fungal disease in non-transplant patients were cryptococcus,aspergillus and mucor.The lung and the brain were the mostly involved organs.Compared to cryptococcus,invasive fungal disease caused by other fungal pathogens mainly occurred in patients with serious underlying diseases and risk factors.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2014年第7期487-491,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金（81273571,81001427）
江苏省科技厅科技支撑计划（BE2011801）
江苏省临床医学研究中心（BL2012012）
