2000～2019年中国大陆地区脑曲霉病回顾性分析  

Retrospective analysis of cerebral aspergillosis in China's Mainland from 2000 to 2019

作　　者：薛强 雷岩 张超 廖万清 侯立军 XUE Qiang;LEI Yan;ZHANG Chao;LIAO Wan-qing;HOU Li-jun(Department of Neurosurgery, Changzheng Hospital, Naval military medical university, Shanghai 200003;Shanghai Neurosurgical Institute, Shanghai 200003;Department of Dermatology and Venereology, Changzheng Hospital, Naval military medical university, Shanghai 200003;Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai 200003)

机构地区：[1]海军军医大学长征医院神经外科,上海200003 [2]上海市神经外科研究所,上海200003 [3]海军军医大学长征医院皮肤科,上海200003 [4]上海市医学真菌分子生物学重点实验室,上海200003

出　　处：《中国真菌学杂志》2019年第3期134-140,共7页Chinese Journal of Mycology

基　　金：军队“十二五”重点课题(BWS12J025);上海市优秀学科带头人基金(XBR2013075);上海市科委扬帆计划(17YF1425100)

摘　　要：目的 对2000~2019年中国大陆地区的脑曲霉病病例进行回顾性分析,为脑曲霉病的早期诊断和正确治疗提供依据指导。方法 收集39例脑曲霉病患者性别、年龄、地域、临床表现、伴随疾病、治疗方法及预后信息,进行回顾性分析。结果 本病可发生于免疫功能缺陷和免疫功能正常者,尤其好发于中年男性;中枢神经系统的感染多来自于肺曲霉病的血行播散和鼻旁窦曲霉病的直接蔓延,早期缺乏特异性的症状,患者主诉以头痛、呕吐等颅内高压症状为主,约至一半的患者(53.85%)可出现发热症状。本病治疗以外科手术干预联合抗真菌治疗最优,药物首选伏立康唑,但预后较差,患者死亡率较高。结论 脑曲霉病是一种临床症状不典型、实验室或影像学检查结果不特异、诊断较为困难、死亡率较高的疾病。Objective To help early diagnosis and efficacious treatment of central nervous system(CNS) aspergillosis, we reviewed 39 cases in China since 2001. Methods We collected and analyzed retrospectively the information of patients' sex and aged composition, geographical features, clinical manifestations, associated diseases, therapeutic methods and outcomes. Results CNS aspergillosis could involve immunocompromised patients and immunocompetent patients, predominantly in middle aged men. The infection of CNS often resulted from the dissemination of the Aspergillus from lungs and paranasal sinuses. There were no early specific symptoms. The chief complaint was usually the symptoms of increased intracranial pressure, with half fever(51.28%). The combination of antifungal therapy with neurosurgery seems to be the most efficacious approach, and voriconazole was the best one. This disease had a poor prognosis, with high mortality. Conclusions With atypical clinical symptoms, nonspecific laboratory or imaging findings, and difficult diagnosis, CNS aspergillosis was still a disease with high mortality.

关 键 词：脑曲霉病 中枢神经系统感染 伏立康唑 

分 类 号：R519.8[医药卫生—内科学]