肺癌患者化疗期间肺部真菌感染病原菌分布及使用伊曲康唑的疗效观察  

Distribution of pathogenic bacteria in pulmonary fungal infection during chemotherapy and therapeutic efficacy of itraconazole in patients with lung cancer

作　　者：姚慧娟[1] 付世东 李冬[2] YAO Hui-juan;FU Shi-dong;LI Dong(Department of Respiratory Medicine,Yan'an People's Hospital,Yan'an 716000,China;Department of Radiotherapy,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]陕西省延安市人民医院呼吸内科,延安716000 [2]陕西省汉中市中心医院放疗科,汉中723000

出　　处：《中国肿瘤临床与康复》2019年第12期1444-1447,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨肺癌患者化疗期间肺部真菌感染病原菌分布及使用伊曲康唑的治疗效果。方法选取2016年8月至2018年12月间延安市人民医院收治的397例肺癌患者的临床资料进行回顾性分析,临床资料包括患者感染发生情况、感染病原菌及其耐药性、治疗前后中性粒细胞、炎症因子水平和肺功能等资料,并进行统计学分析。结果肺癌患者化疗期间肺部真菌感染病原菌以烟曲霉菌、新生隐球菌以及白色假丝酵母菌的感染概率最高,在感染患者中的占比分别是26.2%、23.8%和23.8%。热带假丝酵母菌、光滑假丝酵母菌及毛霉菌的感染概率均较小。两性霉素B的耐药率总体高于伊曲康唑,尤其是主要感染菌烟曲霉菌、新生隐球菌以及白色假丝酵母菌对两性霉素的耐药率分别为18.2%、10.0%和30.0%,均高于对伊曲康唑的耐药率,差异均有统计学意义(均P<0.05)。患者治疗后中性粒细胞计数明显少于治疗前,而超敏C反应蛋白(hs-CRP)、降钙素原(PCT)以及白介素-6(IL-6)水平在治疗后明显比治疗前高,差异均有统计学意义(均P<0.05)。患者治疗后最大呼气第一秒呼出气体量容积(FEV1)、用力呼气量(FVC)和FEV1/FVC各指标水平均较治疗前有大幅度提升,差异均有统计学意义(均P<0.05)。结论肺癌患者化疗后真菌感染率较高,尤其是烟曲霉菌、新生隐球菌以及白色假丝酵母菌,且患者采用伊曲康唑治疗效果较好,可以推广应用。Objective To explore the distribution of pathogenic bacteria in pulmonary fungal infection during chemotherapy and therapeutic efficacy of itraconazole in patients with lung cancer.Methods The clinical data of 397 patients with lung cancer who admitted to Yan’an People’s Hospital from August2016 to December 2018 were retrospectively analyzed.Statistical analysis was performed on the incidence of infection,pathogens,resistance,level of neutrophils and inflammatory factors,and lung function before and after treatment.Results Aspergillus fumigatus,Cryptococcus neoformans,and Candida albicans had the highest infection probability,accounting for 26.2%,23.8%,and 23.8%,respectively.Candida tropicalis,Candida glabrata and mucormycosis also have relatively low probability of infection.The resistance rate for amphotericin B was higher than for itraconazole.Resistance to amphotericin B was 18.2%,10.0%and30.0%,respectively for Aspergillus fumigatus,Cryptococcus neoformans and Candida albicans,which were higher than to itraconazole(all P<0.05).The level of neutrophils was lower after the treatment than before the treatment(P<0.05).However,the levels of hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT),and interleukin(IL)-6 were higher after the treatment than before the treatment(P<0.05).Patients’Forced expiratory volume in 1 second(FEV1),forced expiratory volume(FVC),and FEV1/FVC levels were significantly improved after the treatment(all P<0.05).Conclusion The rate of fungal infection was significantly increased,especially for Aspergillus fumigatus,Cryptococcus neoformans,and Candida albicans after chemotherapy in patients with lung cancer.The efficacy of itraconazole was good and worthy of promotion.

关 键 词：肺肿瘤 化疗 真菌感染 伊曲康唑 

分 类 号：R734.2[医药卫生—肿瘤]