山东“10·21”辐射事故2例放射病病人真菌感染的实验鉴定和动态观察  

Identification and dynamic observation of fungous infections in two patients of ^(60)Co γ accident

作　　者：陈建魁[1] 尹秀云[1] 高峰[1] 张树增[1] 高亚兵[1] 宋世平[1] 黄媛[1] 艾辉胜[2] 余长林[2] 乔建辉[2] 金欣[1] 佟雅丽[1] 杜宇[1] 朱晓华[1] 

机构地区：[1]解放军第307医院检验科,北京100071 [2]解放军第307医院血液科,北京100071

出　　处：《解放军医学杂志》2007年第4期299-301,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家863计划资助项目(2002AA216081)

摘　　要：目的分析引起山东“10·21”辐射事故2例放射病人真菌感染的种类和药敏试验结果。方法用形态学方法结合VITEK(2全自动微生物分析仪以及API 20C AUX生化鉴定方法对临床标本进行微生物学鉴定,真菌药敏试验采用微量稀释法。结果在病例A的大便标本中培养出近平滑念珠菌,中段尿、血液、胸水、腹水、大便、骨髓血、两次咽拭子和脑脊液等标本中培养出申克孢子丝菌,痰液标本中培养出热带念珠菌。病例B的鼻腔、口腔、尿道口分泌物和腹腔引流液等标本中培养出阿萨丝孢酵母菌,痰标本中除阿萨丝孢酵母菌外,还培养出了土曲霉菌。随着抗真菌药物使用时间的延长,上述真菌对抗真菌药物的敏感性逐渐下降,最小抑菌浓度(MIC)逐渐增加。结论大多数抗真菌药物的体外药敏试验敏感,但患者的一般情况很差,常用剂量乃至较大剂量的用药只能抑菌而不能杀菌,且因临床预防性抗生素和抗真菌制剂的使用,常规的微生物培养方法很难培养出细菌或真菌。Objective To identify the fungi isolated from two acute radiation sickness （ARS） patients as a result of an accidental ^60Co irradiation, and to observe the sensitivity of the fungi to antifungal agents. Methods The pathogenic fungi were morphologically examined and identified with the VITEK 2 automatic microorganism analyzer and API 20C AUX yeast identifying card. The susceptibility of fungi to antifungal agents was tested with broth microdilution method. Results Candida parapsilosis and Sporothrix schenchii were identified from case A in the samples of blood, bone marrow, urine and stool etc. Most of pathogenic fungi were sensitive to the antifungal drugs in vitro. In case B, Candida parapsilosis, Candida tropicalis, Trichosporon asahii and Aspergillus terreus were identified in the samples of sputum, urine or stool etc. Accompanying with the prolongation of antifungal treatment, the sensitivity of fungi to the antifungal drugs were decreased remarkably. Conclusion Multiple infections in different organs could be caused by pathogenic ftmgi, such as Trichosporon asahii and Sporothrix schenckii. Although most of pathogenic fungi were sensitive to the antifungal drugs in vitro, the effects Of antifungal treatment were not satisfactOry owing tO poor general conditions of 2 acute radiation sickness （ARS） patients and marked compromise of the immune system. Because of antibiotic and antifungal drugs were used early for preventive purpose, the clinical samples should be specially treated in order to raise the positive rate of fungal identification.

关 键 词：辐射损伤 真菌病 念珠菌病 阿萨丝孢酵母菌 申克氏孢子丝菌 

分 类 号：R818.05[医药卫生—放射医学]