复治肺结核并发肺部真菌感染的易患因素及用药分析  

Susceptible Factors of Retreatment Pulmonary Tuberculosis Complicating with Pulmonary Fungal Infection and Analysis of Drug Use

作　　者：党殿杰 路振宇[1] 刁淑梅 张丹[1] 张丁[1] 

机构地区：[1]邯郸市传染病医院肝八科,河北邯郸056002

出　　处：《中国药房》2014年第26期2432-2434,共3页China Pharmacy

基　　金：河北省邯郸市科学技术研究与发展计划项目(No.0723108132)

摘　　要：目的:探讨复治肺结核并发肺部真菌感染的易患因素、常见菌种及用药特点。方法:整理2012-2013年我院收治的60例复治肺结核并发肺部真菌感染患者的临床资料,对病史、真菌菌种分类、易患因素、诊治及预后进行分析。结果:复治肺结核并发肺部真菌感染的好发人群及易患因素包括高龄、病程长、合并慢性消耗性疾患、有创操作及滥用抗生素和激素等。检出的真菌种类以酵母菌属为主,其中白色念珠菌35例(58.33%),光滑念珠菌15例(25.00%),热带念珠菌6例(10.00%),曲霉菌4例(6.67%)。主要采用2SHRZE/6HRE抗结核化疗方案联合应用氟康唑、酮康唑、伏立康唑、5-氟胞嘧啶、两性霉素B等抗真菌治疗,其中31例治愈(51.67%),27例好转(45.00%),2例无效(3.33%),无死亡病例。结论:临床应避免滥用抗生素和激素,积极治疗基础疾病,加强营养支持,注意调节增强机体免疫功能,从而提高复治肺结核的治愈率。OBJECTIVE： To explore the susceptible factors, common species and medication features of retreatment pulmonary tuberculosis complicating with pulmonary fungal infection. METHODS ： Clinical data of 60 cases of retreatment pulmonary tuberculosis complicating with pulmonary fungal infection in our hospital from 2012 to 2013 were summarized and analyzed in respects of medical history, classification of fungal strains, high risk factors, treatment and prognosis. RESULTS： The high risk group and factors of retreatment pulmonary tuberculosis complicating with pulmonary fungal infection included advanced age, long disease course, chronic wasting disease, invasive operation and abuse of antibiotics and hormones, etc. Saccharomycetes was main fungal species, among which there were 35 cases of Candida albicans （58.33%）] 15 cases of Candida glabrata （25.00%）, 6 cas- es of Oidium tropioale （10.00%） and 4 cases of Aspergillus （6.67%）. Main therapy scheme was 2SHRZE/6HRE anti-tuberculosis chemotherapy combined with fluconazole, ketoconazole, voriconazole, 5-fluorocytosine, amphotericin B. 31 cases were cured （51.67%）, 27 cases improved （45.00%）, and 2 cases invalid （3.33%）. No death case was found. CONCLUSIONS： It is suggest- ed to avoid abuse of antibiotics and hormones, treat basic diseases actively, strengthen nutrition support, pay attention to adjust and enhance the body＇s immune function, so as to improve the cure rate of retreatment pulmonary tuberculosis.

关 键 词：肺结核 复治 真菌感染 

分 类 号：R978.5[医药卫生—药品] R978.3[医药卫生—药学]