加强深部真菌感染的诊治:新的选择  

Emphasis of the diagnosis and management for invasive fungal infection: a new choice

作　　者：王岱明[1] 

机构地区：[1]复旦大学附属儿科医院,上海200032

出　　处：《临床儿科杂志》2006年第7期543-545,共3页Journal of Clinical Pediatrics

摘　　要：随着医学进步,器官移植、化疗、导管介入等措施日益增多以及广谱抗生素的广泛应用,真菌感染的发病明显增加。深部真菌感染的病原菌包括隐球菌、曲霉菌、毛霉菌、球孢子菌等,及以往被认为是条件致病菌的白色念珠菌。在免疫功能低下者,深部真菌感染的发病率和病死率均很高。近年国内外对真菌病诊断的研究取得了一些新进展。临床上已有用真菌显色培养法鉴别多种不同的念珠菌、隐球菌、球孢子菌及酵母菌,其测定真菌感染者血清、尿液或脑脊液中真菌的特异性荚膜多糖,敏感性可高达99%,对鉴别各种真菌感染有重要作用。两性霉素B是治疗侵袭性真菌病的首选药,随着耐药菌的出现,治疗常不满意。新研制的抗真菌药物中伏立康唑、卡泊芬净、宓卡芬净、棘白菌素等已进入市场,可用以治疗耐药真菌感染。Advance in medical technology including organ transplantation, chemotherapy, wide use of broad-spectrum antibiotics and indewelling catheters contributed to the increase of fungal infections. Systemic mycoses may be caused by Cryptococcus ,Aspergillus, Mucor, Coccidioides, or by opportunistic fungi such as Candida albicans. The morbility and mortality is high in immunosuppressed patients.Recent progress in diagnostic technique of Chromatic agar culture method have been established for identification of variant Candida,Cryptococcus,Coccidioides and yeast. Detection of specific fungus capsular polysaccharides from serum,urine or cerebruspinal fluid gave the sensitivity of 99 % for differential diagnosis of fungus. In addition to amphotericin B,new antifungal agents such as voriconazole,caspofungin,micafungin,echinodandin are avaliable for the treatment of invasive fungal infections caused by resistant strains.

关 键 词：真菌感染 诊断 治疗 

分 类 号：R725.1[医药卫生—儿科]