中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
33期
2690-2694
,共5页
詹良敏%黄亮%曲俊彦%钟册俊%吕晓菊
詹良敏%黃亮%麯俊彥%鐘冊俊%呂曉菊
첨량민%황량%곡준언%종책준%려효국
念珠菌病%危险因素%微生物敏感性试验%预后
唸珠菌病%危險因素%微生物敏感性試驗%預後
념주균병%위험인소%미생물민감성시험%예후
Candidiasis%Risk factors%Microbial sensitivity tests%Prognosis
目的 探讨念珠菌血症的临床特点及预后,为临床诊断和合理用药提供依据.方法 收集四川大学华西医院2010年1月至2014年6月住院患者中122例念珠菌血症病例,回顾性分析患者的临床特点、危险因素、念珠菌种类分布、药敏情况、治疗和转归.结果 男占85.2％,女14.8％,年龄(56.0±15.6)岁.69.7％有2种及2种以上基础疾病,88.5％有3个或3个以上危险因素.所有患者均有畏寒、发热,多为中高热(86.9％),伴随有各系统不同症状,出现外周血白细胞升高(82.8％),转氨酶升高(49.2％)和血清肌酐升高(41.0％).122株念珠菌中白念珠菌占34.4％,热带念珠菌26.2％,光滑念珠菌18.9％,近平滑念珠菌14.8％,不同念珠菌对各种抗真菌药物有不同的耐药率.出院时病情好转或治愈67例,死亡或自动出院55例,病死率45.1％.Logistic回归分析显示,机械通气(OR =4.9,P=0.02)、恶性肿瘤(OR=11.39,P=0.01)以及糖尿病(OR =5.93,P=0.02)与死亡独立相关,在血培养报阳前经验性抗真菌治疗病死率降低(OR =0.12,P=0.03).结论 积极治疗基础疾病有利于提高临床疗效,及时合理的经验性抗真菌治疗是降低其病死率的关键.
目的 探討唸珠菌血癥的臨床特點及預後,為臨床診斷和閤理用藥提供依據.方法 收集四川大學華西醫院2010年1月至2014年6月住院患者中122例唸珠菌血癥病例,迴顧性分析患者的臨床特點、危險因素、唸珠菌種類分佈、藥敏情況、治療和轉歸.結果 男佔85.2％,女14.8％,年齡(56.0±15.6)歲.69.7％有2種及2種以上基礎疾病,88.5％有3箇或3箇以上危險因素.所有患者均有畏寒、髮熱,多為中高熱(86.9％),伴隨有各繫統不同癥狀,齣現外週血白細胞升高(82.8％),轉氨酶升高(49.2％)和血清肌酐升高(41.0％).122株唸珠菌中白唸珠菌佔34.4％,熱帶唸珠菌26.2％,光滑唸珠菌18.9％,近平滑唸珠菌14.8％,不同唸珠菌對各種抗真菌藥物有不同的耐藥率.齣院時病情好轉或治愈67例,死亡或自動齣院55例,病死率45.1％.Logistic迴歸分析顯示,機械通氣(OR =4.9,P=0.02)、噁性腫瘤(OR=11.39,P=0.01)以及糖尿病(OR =5.93,P=0.02)與死亡獨立相關,在血培養報暘前經驗性抗真菌治療病死率降低(OR =0.12,P=0.03).結論 積極治療基礎疾病有利于提高臨床療效,及時閤理的經驗性抗真菌治療是降低其病死率的關鍵.
목적 탐토념주균혈증적림상특점급예후,위림상진단화합리용약제공의거.방법 수집사천대학화서의원2010년1월지2014년6월주원환자중122례념주균혈증병례,회고성분석환자적림상특점、위험인소、념주균충류분포、약민정황、치료화전귀.결과 남점85.2％,녀14.8％,년령(56.0±15.6)세.69.7％유2충급2충이상기출질병,88.5％유3개혹3개이상위험인소.소유환자균유외한、발열,다위중고열(86.9％),반수유각계통불동증상,출현외주혈백세포승고(82.8％),전안매승고(49.2％)화혈청기항승고(41.0％).122주념주균중백념주균점34.4％,열대념주균26.2％,광활념주균18.9％,근평활념주균14.8％,불동념주균대각충항진균약물유불동적내약솔.출원시병정호전혹치유67례,사망혹자동출원55례,병사솔45.1％.Logistic회귀분석현시,궤계통기(OR =4.9,P=0.02)、악성종류(OR=11.39,P=0.01)이급당뇨병(OR =5.93,P=0.02)여사망독립상관,재혈배양보양전경험성항진균치료병사솔강저(OR =0.12,P=0.03).결론 적겁치료기출질병유리우제고림상료효,급시합리적경험성항진균치료시강저기병사솔적관건.
Objective To analyze the clinical characteristics of patients with candidemia for better clinical diagnosis and management of the disease.Method A retrospective study was carried out in 122 patients with confirmed diagnosis of candidemia from January 2010 to June 2014 in West China hospital of Sichuan University.The clinical features,risk factors,laboratory tests,treatments and clinical outcomes were reviewed and analyzed.Results The clinical symptoms mainly include chill,shivering and fever (moderate fever or high fever).A total of 85 patients (69.7％) complicated with more than or equal to two kinds of underlying diseases,and 108 patients (88.5％) have more than or equal to three risk factors.There were 82.8％ patients with increased white blood cell counts,49.2％ patients with elevated aminotransferase levels and 41.0％ patients with increased creatinine levels.The isolated strains were albicans (42,34.6％),tropicalis (32,26.2％),glabrata (23,18.9％) and parapsilosis (18,14.8％).Susceptibility tests indicated some strains were resistant to antifungal drugs.Sixty-seven patients were cured or improved,55 died or discharged voluntarily.The mortality rate was 45.1％.The multivariate Logistic regression analysis showed the independent correlative factors of mortality were mechanical ventilation (OR =4.9,P =0.02),malignancy (OR =11.39,P =0.01) and diabetes (OR =5.93,P =0.02).Early empiric antifungal therapy helped reduce the fatality rate (OR =0.12,P =0.03).Conclusion Actively treating underlying diseases can improve the clinical effect.The key to decrease the mortality is appropriate antifungal chemotherapy.
