中国感染控制杂志
中國感染控製雜誌
중국감염공제잡지
CHINESE JOURNAL OF INFECTION CONTROL
2015年
4期
227-231
,共5页
慢性阻塞性肺疾病%真菌%伊曲康唑%肺部感染%肺真菌感染%危险因素%治疗
慢性阻塞性肺疾病%真菌%伊麯康唑%肺部感染%肺真菌感染%危險因素%治療
만성조새성폐질병%진균%이곡강서%폐부감염%폐진균감염%위험인소%치료
chronic obstructive pulmonary disease%fungus%itraconazole%pulmonary infection%pulmonary fungal infection%risk factor%treatment
目的：了解慢性阻塞性肺疾病（COPD）合并肺真菌感染的危险因素，评价伊曲康唑治疗 COPD 合并肺真菌感染的疗效和安全性。方法回顾分析2007年9月1日—2012年5月31日某院呼吸内科诊断为肺真菌感染并接受伊曲康唑治疗的42例 COPD 患者临床资料，随机抽取同期住院53例 COPD 不伴肺真菌感染患者作为对照。结果42例COPD 合并肺真菌感染患者，经肺组织病理学检查确诊8例，临床诊断34例；急性病例6例，慢性病例36例；真菌检查阳性者共28例，其中检出白假丝酵母菌6例，曲霉菌13例，未分类真菌7例，混合感染2例。单因素分析结果显示，合并基础疾病、长期使用广谱抗菌药物、长期使用肾上腺糖皮质激素、低蛋白血症、侵入性操作、有创机械通气、糖尿病、侵入性真菌病感染史是 COPD 合并肺真菌感染的主要危险因素。伊曲康唑治疗后，患者临床症状改善率为66．67％，真菌清除率为60．71％，总有效率为64．29％；28例真菌检查阳性患者临床症状改善率、真菌清除率和综合疗效评价总有效率分别为71．43％（20例）、60．71％（17例）、67．86％（19例）。伊曲康唑治疗COPD 合并肺真菌的急、慢性感染患者，以及 COPD 白假丝酵母菌和曲霉菌感染患者均具有良好的治疗效果。药物不良反应发生率为23．81％，多数轻微可逆，未对治疗造成明显影响。结论伊曲康唑治疗 COPD 合并肺真菌感染疗效确切，安全性良好。
目的：瞭解慢性阻塞性肺疾病（COPD）閤併肺真菌感染的危險因素，評價伊麯康唑治療 COPD 閤併肺真菌感染的療效和安全性。方法迴顧分析2007年9月1日—2012年5月31日某院呼吸內科診斷為肺真菌感染併接受伊麯康唑治療的42例 COPD 患者臨床資料，隨機抽取同期住院53例 COPD 不伴肺真菌感染患者作為對照。結果42例COPD 閤併肺真菌感染患者，經肺組織病理學檢查確診8例，臨床診斷34例；急性病例6例，慢性病例36例；真菌檢查暘性者共28例，其中檢齣白假絲酵母菌6例，麯黴菌13例，未分類真菌7例，混閤感染2例。單因素分析結果顯示，閤併基礎疾病、長期使用廣譜抗菌藥物、長期使用腎上腺糖皮質激素、低蛋白血癥、侵入性操作、有創機械通氣、糖尿病、侵入性真菌病感染史是 COPD 閤併肺真菌感染的主要危險因素。伊麯康唑治療後，患者臨床癥狀改善率為66．67％，真菌清除率為60．71％，總有效率為64．29％；28例真菌檢查暘性患者臨床癥狀改善率、真菌清除率和綜閤療效評價總有效率分彆為71．43％（20例）、60．71％（17例）、67．86％（19例）。伊麯康唑治療COPD 閤併肺真菌的急、慢性感染患者，以及 COPD 白假絲酵母菌和麯黴菌感染患者均具有良好的治療效果。藥物不良反應髮生率為23．81％，多數輕微可逆，未對治療造成明顯影響。結論伊麯康唑治療 COPD 閤併肺真菌感染療效確切，安全性良好。
목적：료해만성조새성폐질병（COPD）합병폐진균감염적위험인소，평개이곡강서치료 COPD 합병폐진균감염적료효화안전성。방법회고분석2007년9월1일—2012년5월31일모원호흡내과진단위폐진균감염병접수이곡강서치료적42례 COPD 환자림상자료，수궤추취동기주원53례 COPD 불반폐진균감염환자작위대조。결과42례COPD 합병폐진균감염환자，경폐조직병이학검사학진8례，림상진단34례；급성병례6례，만성병례36례；진균검사양성자공28례，기중검출백가사효모균6례，곡매균13례，미분류진균7례，혼합감염2례。단인소분석결과현시，합병기출질병、장기사용엄보항균약물、장기사용신상선당피질격소、저단백혈증、침입성조작、유창궤계통기、당뇨병、침입성진균병감염사시 COPD 합병폐진균감염적주요위험인소。이곡강서치료후，환자림상증상개선솔위66．67％，진균청제솔위60．71％，총유효솔위64．29％；28례진균검사양성환자림상증상개선솔、진균청제솔화종합료효평개총유효솔분별위71．43％（20례）、60．71％（17례）、67．86％（19례）。이곡강서치료COPD 합병폐진균적급、만성감염환자，이급 COPD 백가사효모균화곡매균감염환자균구유량호적치료효과。약물불량반응발생솔위23．81％，다수경미가역，미대치료조성명현영향。결론이곡강서치료 COPD 합병폐진균감염료효학절，안전성량호。
Objective To study the risk factors for pulmonary fungal infection associated with chronic obstructive pulmonary disease (COPD),and evaluate the efficacy and safety of itraconazole for treatment of pulmonary fungal infection associated COPD.Methods A retrospective analysis were conducted on clinical data of 42 COPD patients who were confirmed pulmonary fungal infection in a respiratory disease department from September 1 ,2007 to May 31 ,2012,and 53 COPD patients who had no pulmonary fungal infection were as control.Results Of 42 patients with COPD and pulmonary fungal infection,8 were confirmed by histopathological examination,34 were confirmed by clinical diagnosis;6 were acute cases,36 were chronic cases;28 were positive for fungal detection,6 of whom were detected Candida albicans ,13 were detected Aspergillus ,7 were detected unclassified fungi,and 2 had mixed fungal infection.Univariate analysis showed that underlying diseases,long-term use of broad-spectrum antimicrobi-als,long-term use of glucocorticoid,hypoproteinemia,invasive procedure,invasive mechanical ventilation,diabetes mellitus,history of invasive fungal infection were major risk factors for pulmonary fungal infection associated with COPD.After patients were treated by itraconazole,the improvement rate of clinical symptoms was 66.67%,fungal eradication rate was 60.71 %,total effective rate was 64.29%.Of 28 cases with positive fungal detection,the im-provement rate of clinical symptoms,fungal eradication rate,and total effective rate was 71 .43%(n=20),60.71 %(n=17),and 67.86%(n=19)respectively.Itraconazole had good therapeutic efficacy on acute and chronic pulmo-nary fungal infection associated with COPD.Adverse drug reaction rate was 23.81 %,most were mild and reversi-ble,and had no obvious impact on the treatment.Conclusion Itraconazole has positive clinical efficacy on treating pulmonary fungal infection associated with COPD,it is highly safe.
