白血病粒细胞缺乏期肺侵袭性真菌感染患者的病原学分析  

Etiological analysis of invasive pulmonary fungal infections in leukemia patients during agranulocytosis period

作　　者：陆米则[1] 夏珺[1] 程枫[1] 

机构地区：[1]无锡市人民医院血液科,江苏无锡214001

出　　处：《中华医院感染学杂志》2014年第6期1333-1335,共3页Chinese Journal of Nosocomiology

基　　金：无锡市科技发展指令性计划基金项目(CSLYLN1101)

摘　　要：目的探讨白血病粒细胞缺乏期肺侵袭性真菌感染患者的病原学分布,并分析其中生化指标的改变,以期为该病的临床诊治提供依据。方法回顾性分析2011年12月-2013年1月在医院治疗的50例白血病粒细胞缺乏期肺侵袭性真菌感染患者为真菌组,另外随机选取同时期的50例细菌感染的患者为细菌组,对真菌组进行病原学分析,并对两组患者进行生化监测,分析其在生化指标上的差异性,采用SPSS13.0软件进行统计分析。结果白血病粒细胞缺乏期肺侵袭性真菌感染的真菌种类以白色假丝酵母菌为主,占45.1%,标本来源以痰液最常见占40.0%;检出的假丝酵母菌属除克柔假丝酵母菌外对氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑等敏感率高,均>80.0%,毛霉菌属的敏感率均为100.0%;生化指标中位值在真菌感染和细菌感染上差异明显,且两组对不同的β-D葡聚糖(1,3)和甘露聚糖的阈值也有明显的敏感性和特异性。结论白血病粒细胞缺乏期肺侵袭性真菌感染患者的病原菌以白色假丝酵母菌为主,对氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑等敏感性的真菌以毛霉菌属和光滑假丝酵母菌居多,而-β-D葡聚糖、甘露聚糖可明确真菌感染。OBJECTIVE To explore the etiology of invasive pulmonary fungal infections in leukemia patients during agranulocytosis period and analyze the change of biochemical indicators so as to provide bases for the clinical diagnosis and treatment. METHODS Totally 50 leukemia agranulocytosis patients complicated with invasive pulmonary fungal infections, who were treated in the hospital from Dec 2011 to Jan 2013, were chosen as the fungi group, while 50 patients complicated with bacterial infections were randomly selected as the bacteria group, then the etiological analysis was performed, the biochemical surveillance was conducted, the differences in the biochemical indicators were observed, and the statistical analysis was performed with the use of SPSS 13.0 software. RESULTS Candida albicans was the predominant species of fungi causing the pulmonary invasive fungal infections in the leu- kemia agranulocytosis patients, accounting for 45. 1%; the sputum was the most common sputum specimens, accounting for 40.0 %. The drug susceptibility rates of the Candida glabrata to 5-fluorine cytosine, amphotericin B, fluconazole, itraconazole, and voriconazole were more than 80.0%; the drug susceptibility rates of the Mucor were 100.0% ; there was significant difference in the medial value of sum of the biochemical indicators between the fungal infection group and the bacterial infection group, and the thresholds of B-D glucan and mannans of both groups had significant sensitivity and specificity. CONCLUSION The C. albicans is the predominant species of pathogens causing the invasive pulmonary fungal infections in the leukemia agranulocytosis patients. Mucor and C. glabrata are dominant among the pathogens that are susceptible to 5-fluorine cytosine, amphotericin B, fluconazole, itraconazole, and voriconazole. The fungal infections can be defined through the biochemical indicators, including the B-D glucan and mannans.

关 键 词：白血病 粒细胞缺乏期 肺侵袭性真菌感染 病原学 生化指标 

分 类 号：R379[医药卫生—病原生物学]