861例艾滋病合并马尔尼菲蓝状菌病的临床分析  

Clinical analysis on 861 cases of acquired immune deficiency syndrome complicated with penicilliosis marneffei infection

作　　者：李英[1] 卢斯汉[1] 胡荣欣[1] 杜健群[1] 柯迎春[1] 李水凤[1] 王军雄[1] 梁健瑜[1] 许婍娴 吴琼贤 郭淑娟 LI Ying;LU Si-han;HU Rong-xin;DU Jian-qun;KE Ying-chun;LI Shui-feng;WANG Jun-xiong;LIANG Jian-yu;XU Qi-xian;WU Qiong-xian;GUO Shu-juan(Guangzhou Eighth People＇s Hospital,Guangzhou,Guangdong 510060,China)

机构地区：[1]广州市第八人民医院皮肤科,广东广州510060

出　　处：《热带医学杂志》2018年第7期939-942,950,共5页Journal of Tropical Medicine

基　　金：广州市卫生局医药卫生科技项目(20151A010053)

摘　　要：目的探讨艾滋病合并马尔尼菲蓝状菌病(PSM)的临床表现特点及实验室特征,比较三种抗真菌药物治疗的疗效。方法回顾性分析2013年1月至2016年12月期间于广州市第八人民医院收治明确诊断为艾滋病合并PSM的861例患者临床及实验室资料,分析两性霉素B、伏立康唑、伊曲康唑治疗后病情转归情况。结果 861例患者中死亡病例占14.98%(129/861)。临床表现以发热(89.66%)、皮疹(64.92%)、消瘦(64.46%)、咳嗽(49.24%)、贫血(39.26%)、淋巴结肿大(28.57%)为主,当患者合并消瘦、淋巴结肿大、肝肿大、腹水、呼吸困难及其他机会性感染时,死亡风险明显增高。实验室检查出现白细胞下降、白蛋白减少、乳酸脱氢酶升高和CD4^+T淋巴细胞减少时,提示预后欠佳。521例患者分别使用两性霉素B、伏立康唑、伊曲康唑治疗,症状改善后给予口服伊曲康唑长期治疗,死亡率分别为8.5%、7.1%、6.6%,三种药物比较,死亡率差异无统计学意义(χ~2=0.512,P>0.05)。结论艾滋病合并PSM临床表现多样。抗真菌药物治疗均具有良好的疗效。Objective This study aimed to explore the clinical characteristics and laboratory parameters of acquired immunedeficiency syndrome（AIDS）combined with penicilliosis marneffei（PSM）infection,and compare the efficacy of threeantifungal drugs.Methods A retrospective study was conducted on all patients with definitive diagnosis of acquiredimmune deficiency syndrome complicated with Penicillium marneffei infection admitted to Guangzhou Eighth People′ sHospital between January 2013 and December 2016.Results In total,861 cases were collected,with the majority ofmales,including 129 deaths,accounting for 14.98%.Clinical manifestation included fever（89.66%）,rash（64.92%）,lose weight（64.46%）,cough（49.24%）,anemia（39.26%）,and lymph node enlargement（28.57%）.The risk of deathincreased obviously,when patients combined with lose weight,lymphadenectasis,hepatomegaly,ascites,dyspnea andother opportunistic infections.It was suggested a poor prognosis was associated with decreased white blood cells,decreasedalbumin,elevated lactate dehydrogenase,and decreased CD4~＋T lymphocytes.The mortality rates of using amphotericin B,voriconazole,itraconazole and then giving oral antifungal drug for long-term treatment were 8.5%,7.1% and 6.6%,respectively.The differences in the mortality rates of the three antifungal drugs was not significant（χ~2=0.512,P〈0.05）.Conclusion The clinical manifestations of AIDS complicated with penicilliosis marneffei infection were diversed.Antifungal therapy was effective.

关 键 词：马尔尼菲蓝状菌病 艾滋病 抗真菌治疗 

分 类 号：R512.91[医药卫生—内科学]