2016～2017年河北地区侵袭性真菌感染的病原菌分布特征  

Distribution characteristics of invasive fungal infections in Hebei province from 2016 to 2017

作　　者：栗方 李志荣[3] 赵建宏[3] 赵颖[4] 张延海 董爱英 刘金禄 郭彦言[8] 孙艳 赵文申[10] 谢守军[11] 魏宏莲[12] 张金艳[13] 任宏涛[14] 王建升[15] 吴相锟[5] 光晓 刘冬青 杜红丽[18] 郭映辉 徐英春[4] 肖盟 杨文航 徐晓琳 LI Fang;LI zhi-rong;ZHAO Jian-hong;ZHAO Ying;ZHANG Yan-hai;DONG Ai-ying;LIU Jin-lu;GUO Yan-yan;SUN Yan;ZHAO Wen-shen;XIE Shou-jun;WEI Hong-lian;ZHANG Jin-yan;REN Hong-tao;WANG Jian-sheng;WU Xiang-kun;GUANG Xiao;LI Dong-qing;DU Hong-li;GUO Ying-hui;XU Ying-chun;XIAO Meng;YANG Wen-Hang;XU Xiao-lin(Herbei Yanda hopstial,Langfang 065201;Chao yang Hospital Affilliated to the Capital University of Medical Science,Beijing 100020,China;Clinical Laboratory Center of Hebei Province,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases,Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;North China University of Science and Technology Affiliated Hospital,Tangshan 063000;The First Affiliated Hospital of Hebei North University School of Clinical Medicine,Zhangjiakou 075000;Department of Endocrinology,Tangshan Gongren Hospital,Tangshan 063000;Cangzhou Central Hospital,Cangzhou 061001;The Central Hospital of Handan,Handan 056001;Affiliated Hospital of Chengde Medical College,Chengde 067000;The Second Hospital of Hebei Medical University,Shijiazhuang 050000;Fourth Hospital Affiliated to Hebei Medical University,Shijiazhuang 050019;People’s Hospital of Xingtai City,Xingtai 054001;Hebei Provincial People’s Hospital,Shijiazhuang 050057;The First People’s Hospital of Wu’an City,Wuan 056300;Handan First People’s Hospital,Handan 056002;People’s Hospital of Hengshui City,Hengshui 053000;Hebei Children’s Hospital,Shijiazhuang 050030)

机构地区：[1]河北燕达医院感染与疾病控制部,廊坊065201 [2]首都医科大学附属北京朝阳医院感染与微生物科,北京100020 [3]河北医科大学第二医院河北省临床检验中心,石家庄050000 [4]中国医学科学院北京协和医院检验科侵袭性真菌病机制研究与精准诊断北京市重点实验室,北京100730 [5]河北燕达医院,廊坊065201 [6]华北理工大学附属医院,唐山063000 [7]河北北方学院附属第一医院,张家口075000 [8]河北省唐山市工人医院,唐山063000 [9]沧州市中心医院,沧州061001 [10]邯郸市中心医院,邯郸056001 [11]承德医学院附属医院,承德067000 [12]河北医科大学第二医院,石家庄050000 [13]河北医科大学第四医院,石家庄050019 [14]邢台市人民医院,邢台054001 [15]河北省人民医院,石家庄050057 [16]河北省武安市第一人民医院,武安056300 [17]邯郸市第一医院,邯郸056002 [18]衡水市人民医院,衡水053000 [19]河北省儿童医院,石家庄050030

出　　处：《中国真菌学杂志》2019年第5期257-263,共7页Chinese Journal of Mycology

基　　金：河北省科技计划-重点研发计划项目资助(17277775D);中央高校基本科研业务费专项资金资助项目(3332018041);辉瑞中国抗真菌科研基金项目资助(WS931592)

摘　　要：目的了解2016~2017年河北地区16家三级教学医院侵袭性真菌感染现状,为临床诊治和感染防控提供数据资料。方法各参与单位收集引起侵袭性真菌感染的酵母菌和丝状真菌菌株,中心实验室应用Vitek MS质谱分析进行菌株复核鉴定,对Vitek MS不能有效鉴定的疑难和罕见菌株采用ITS和/或钙调蛋白CaM测序分析。结果16家医院共检出侵袭性真菌493株,其中酵母菌268株(54.36%),丝状真菌225株(45.64%)。酵母菌主要是白念珠菌41.79%,其次是热带念珠菌、近平滑念珠菌和光滑念珠菌。丝状真菌主要是烟曲霉58.22%,其次是黄曲霉/米曲霉和黑曲霉。侵袭性真菌复核正确率(373/493)75.66%。结论引起的侵袭性真菌感染中最常见的是念珠菌为主的酵母菌和曲霉菌为主的丝状真菌。采用微生物质谱鉴定结合ITS/CaM区测序方法可以有效提高真菌的鉴定正确率,为临床侵袭性真菌的治疗提供参考依据。Objective To expore distribution characteristics of invasive fungal infections in 16 tertiary teaching hospitals in Hebei from 2016 to 2017,and to provide data for clinical diagnosis,treatment and infection control.Methods The yeast fungi and filamentous fungi causing invasive fungal infections were collected by member units.The strains were re-examined by Vitek MS analysis in the central laboratory.For difficult and rare strains,ITS and/or calmodulin CaM sequencing were used.Results A total of 493 invasive fungi strains were detected in 16 hospitals from 2016 to 2017,including 268 yeast fungi(54.36%)and 225 filamentous fungi(45.64%).Yeast fungi include 112 strains of C.albicans(41.79%),52 strains of C.tropicalis(19.40%),38 strains of C.parapsilosis(14.18%),29 strains of C.glabrata(10.82%),10 strains of Cryptococcus neoformans(3.73%)and 27 strains of other Candida(10.07%).Filamentous fungi included 131 strains of Aspergillus fumigatus(58.22%),24 strains of Aspergillus flavus/Aspergillus oryzae(10.67%),18 strains of Aspergillus Niger(8.00%),6 strains of Aspergillus sydowii(2.67%),5 strains of Aspergillus nestoris(2.22%)and 41 strains of other filamentous fungi(18.22%).The correct rate of invasive fungi identification was 75.66%(373/493).Conclusion The most common invasive fungal infections were Candida-dominated yeasts and Aspergillus-dominated filamentous fungi.The combination of microbial mass spectrometry identification and ITS/CaM region sequencing could effectively improve the identification accuracy of fungi and provide a reference for clinical treatment of invasive fungi.

关 键 词：侵袭性真菌 酵母菌 丝状真菌 分布特征 

分 类 号：R379[医药卫生—病原生物学]