2008-2012年肺部真菌感染临床分析  

Clinical analysis of pulmonary fungal infections in 2008-2012

作　　者：龙军[1] 张耀康[2] 江凌晓[1] 方艳平[1] 姜长宏[1] 林丽娟[1] 付亮[1] 

机构地区：[1]南方医科大学珠江医院检验医学部,广东广州510280 [2]南方医科大学检验系,广东广州510515

出　　处：《中华医院感染学杂志》2014年第13期3240-3242,共3页Chinese Journal of Nosocomiology

基　　金：广东省科技攻关基金资助项目(2010B031600239)

摘　　要：目的总结肺部真菌感染的临床诊治经验,从而提高临床对肺部真菌感染诊断的认识,以提高诊断率。方法回顾性分析2008年1月-2012年9月医院诊断为肺部真菌感染的132例患者临床特点,分为拟诊组36例、临床诊断组68例、确诊病例组28例,并比较临床实验室检查在诊断肺部真菌感染的价值。结果 132例肺部真菌感染患者中拟诊和确诊、临床诊断患者分别占27.3%、21.2%和51.5%,其中108例患有基础疾病,主要是肺部疾病,其次有肿瘤性疾病和神经系统疾病等;89.4%病例进行了血清1-3-β-D葡聚糖抗原检测(G试验)检查,确诊与临床诊断病例试验阳性率分别是100.0%和85.0%;痰涂片检查与血培养检查阳性率比较低;痰培养阳性率比较高;影像学主要表现为双肺片状影、结节影或高密度影或磨玻璃样改变,24.2%表现为空洞团块影;40例进行病理学检查,28例为阳性,阳性率70.0%;89.7%接受了抗真菌治疗,所用药物以唑类为主,其次是两性霉素B,132例肺部真菌感染患者死亡24例,病死率18.2%。结论肺部真菌感染临床表现缺乏特异性、病死率高,需要行侵入性手段协助诊断以早期诊断和治疗,G试验是灵敏度高、特异性好的方法。OBJECTIVE To summarize the experience of clinical diagnosis and treatment of pulmonary fungal infec- tion so as to improve the understanding of the diagnosis of pulmonary mycosis and improve the diagnostic rate. METHODS The clinical data of 132 patients that were diagnosed with pulmonary fungal infections in hospital from Jan 2008 to Sep 2012 were analyzed retrospectively; the patients were divided into examination group （36 cases）, clinical diagnosis group （68 cases）and confirmed group （28 cases）, and a number of laboratory tests＂ value were compared in the diagnosis of pulmonary mycosis. RESULTS The patients in the examination group, clinical diagno- sis group and confirmed group accounted for 27.3%, 21.2% and 51.5% respectively in the 132 cases of patients with pulmonary fungal infections. There were 108 patients had underlying diseases among them. Lung disease was the main underlying disease, followed by tumor diseases and diseases of nervous system. 89.4% cases were detec- ted the pIasma 1,3-β-D-glucan（G test）, the confirmed cases and cases of clinical diagnosis test positive probability was respectively 100.0% and 85.0%. Sputum smears examination and blood culture positive rate examination was relatively low. The positive rate of sputum culture examination was relatively high. Imaging examination was mainly bilateral patchy shadow, nodules or high density shadow and ground-glass opacity and 24.2% showed emp- ty mass. There were 40 cases of patients underwent pathological examination, the positive rate was 70.0% （28 cases）. 87.9 % received antifungal therapy, the drug was mainly azole, followed by amphotericin B, and there were 24 cases of patients among the 132 patients with pulmonary fungal infection, the case fatality rate was 18.2%. CONCLUSION The clinical symptoms and imaging features are on-specific. The pulmonary fungal infections tend to be highly fatal. Early diagnosis with prompt antifungal therapies may be benefical for these patients. 1,3-β-D- glucan（G test）is a useful

关 键 词：肺部真菌感染 曲霉菌属 G试验 

分 类 号：R563[医药卫生—呼吸系统]