微生物与感染
微生物與感染
미생물여감염
Journal of Microbes and Infections
2015年
5期
275-281
,共7页
艾滋病%侵袭性真菌感染%诊断%治疗
艾滋病%侵襲性真菌感染%診斷%治療
애자병%침습성진균감염%진단%치료
Acquired immunodeficiency syndrome%Invasive fungal infection%Diagnosis%Treatment
人类免疫缺陷病毒（HIV）感染是侵袭性真菌感染（IFI）的危险因素。尽管高效抗反转录病毒治疗（HAART）在临床广泛应用，IFI仍是艾滋病患者常见的机会性感染和死亡原因。艾滋病患者中常见的 IFI有口腔及食管假丝酵母（又称念珠菌）病、肺孢子菌肺炎、隐球菌脑膜炎和马尔尼菲青霉病等。艾滋病合并IFI的诊断有其特殊性和复杂性，临床上需结合患者免疫状况、临床表现、影像学检查及真菌学检测结果来综合分析，不能将用于一般患者的诊断思维简单地应用于艾滋病患者，一些诊断技术的灵敏度和特异度须在艾滋病患者中重新评价。艾滋病合并IFI的治疗包括抗真菌和抗病毒治疗两个必不可少的方面，但应注意药物间的相互作用。IFI治愈或完成治疗疗程后，应根据病情决定是否需要维持抗真菌治疗以减少 IFI复发。对于免疫功能极低的艾滋病患者，须根据病情预防性抗真菌治疗以预防某些IFI发生。艾滋病合并 IFI的早期诊断技术与优化治疗策略有待进一步研究和探索。
人類免疫缺陷病毒（HIV）感染是侵襲性真菌感染（IFI）的危險因素。儘管高效抗反轉錄病毒治療（HAART）在臨床廣汎應用，IFI仍是艾滋病患者常見的機會性感染和死亡原因。艾滋病患者中常見的 IFI有口腔及食管假絲酵母（又稱唸珠菌）病、肺孢子菌肺炎、隱毬菌腦膜炎和馬爾尼菲青黴病等。艾滋病閤併IFI的診斷有其特殊性和複雜性，臨床上需結閤患者免疫狀況、臨床錶現、影像學檢查及真菌學檢測結果來綜閤分析，不能將用于一般患者的診斷思維簡單地應用于艾滋病患者，一些診斷技術的靈敏度和特異度鬚在艾滋病患者中重新評價。艾滋病閤併IFI的治療包括抗真菌和抗病毒治療兩箇必不可少的方麵，但應註意藥物間的相互作用。IFI治愈或完成治療療程後，應根據病情決定是否需要維持抗真菌治療以減少 IFI複髮。對于免疫功能極低的艾滋病患者，鬚根據病情預防性抗真菌治療以預防某些IFI髮生。艾滋病閤併 IFI的早期診斷技術與優化治療策略有待進一步研究和探索。
인류면역결함병독（HIV）감염시침습성진균감염（IFI）적위험인소。진관고효항반전록병독치료（HAART）재림상엄범응용，IFI잉시애자병환자상견적궤회성감염화사망원인。애자병환자중상견적 IFI유구강급식관가사효모（우칭념주균）병、폐포자균폐염、은구균뇌막염화마이니비청매병등。애자병합병IFI적진단유기특수성화복잡성，림상상수결합환자면역상황、림상표현、영상학검사급진균학검측결과래종합분석，불능장용우일반환자적진단사유간단지응용우애자병환자，일사진단기술적령민도화특이도수재애자병환자중중신평개。애자병합병IFI적치료포괄항진균화항병독치료량개필불가소적방면，단응주의약물간적상호작용。IFI치유혹완성치료료정후，응근거병정결정시부수요유지항진균치료이감소 IFI복발。대우면역공능겁저적애자병환자，수근거병정예방성항진균치료이예방모사IFI발생。애자병합병 IFI적조기진단기술여우화치료책략유대진일보연구화탐색。
Human immunodeficiency virus (HIV ) infection is a risk factor for invasive fungal infections (IFIs) .IFI remains one of the major opportunistic infections and a leading cause of infection‐related mortality in HIV/acquired immunodeficiency syndrome (AIDS) patients in spite of the widespread use of highly active antiretroviral therapy (HAART) .The most common IFIs include mucocutaneous candidiasis , pneumocystis pneumonia , cryptococcal meningitis , and penicilliosis marneffei . Compared with non‐HIV infection patients ,the diagnosis of IFI in HIV patients is more complex .Diagnosis should be made through the combined analysis of the immune status of the patients ,clinical manifestations ,imaging examinations and mycological laboratory test results .The diagnostic methodology for IFI in non‐HIV patients should not be simply applied in HIV patients ,and the sensitivity and specificity of some diagnostic techniques should be re‐evaluated in HIV patients .Antifungal therapy and HAART are the two essential aspects of the treatment of HIV co‐infection with IFIs .Attentions should be paid to drug interactions between antifungal agents and HAART .HIV patients who have completed the initial antifungal therapy should be administered chronic maintenance therapy with antifungal drugs according to CD4 cell counts ,drug‐drug interactions and side effects .HIV patients are highly vulnerable to IFIs ,and chemoprophylaxis for high‐risk patients with severe immunosuppression should be initiated to decrease the incidence of special IFIs in HIV patients . Early diagnosis and optimized treatment for IFIs in HIV patients need to be further studied and explored .
