CAJ | 학술논문

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.
목적 료해침습성진균병적병원보、림상특정화역감인소,제고림상의생대진균감염적인식,위림상조기진치제공의거.방법 회고성분석남경의과대학제일부속의원2006 2012년수치적165례비이식침습성진균병환자적림상자료,안조통일표준중신학정진단급별병분석기과실분포、림상표현、병원보급역감인소.결과 165례중,남90례,녀75례,년령14 ～ 90세,평균(54±15)세.호흡과병례52례(31.5％);균군분포이은구균최다(91례,54.9％),기차위곡매(52례,31.4％)화모매(10례,5.9％).폐진균병적림상표현다위해수、해담、각혈급발열,영상학표현다양단무특이성,결절혹실변영교경전적곡매구、훈륜정급신월정경위상견.기출질병전3위의차위당뇨병(26례,15.8％)、만성조새성폐질병(22례,13.3％)화혈액계통악성종류(17례,10.3％),66.1％(109례)적환자존재1충혹다충고위인소(여연합사용항생소≥7 d、침입성조작、장기사용당피질격소혹면역억제제등),합병2충급이상고위인소적환자병사솔승고.결론 비이식환자침습성진균병전3위병원체분별위은구균、곡매급모매,폐화뇌시최상견적감염부위;상대우은구균감염,곡매화모매감염다존재기출질병;저단백혈증화장기사용엄보항생소시상견적역감인소.
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.