临床标本分离的丝状真菌实验室检测与临床特点分析  

Clinical characteristics and laboratory analysis of filamentous fungi isolated from patients

作　　者：曹敬荣[1] 王育英[1] 谢威[1] 王岩[1] 陈典典 李文军[1] 刘云屹 闵嵘[1] 王培昌[1] Cao Jingrong;Wang Yuying;Xie Wei;Wang Yan;Chen Diandian;Li Wenjun;Liu Yunyi;Min Rong;Wang Peichang(Department of Clinical Laboratory,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院检验科,北京100053

出　　处：《国际呼吸杂志》2020年第19期1497-1502,共6页International Journal of Respiration

基　　金：北京市医管局人才培养计划"登峰"项目(DFL20180803);宣武医院院级课题(XWJL-2019031)。

摘　　要：目的:分析临床分离出丝状真菌患者的临床资料和实验室结果,提高对该类感染的认识。方法:回顾性分析2016年1月至2019年1月宣武医院临床标本分离到丝状真菌的住院患者临床资料,包括人口学特征、临床表现、影像学及微生物学结果。比较肺部感染组和定植/污染组及存活组和死亡组的差异,分析导致感染的危险因素。统计学分析采用SPSS 20.0软件。结果:共收集分离丝状真菌的患者110例,男70例,女40例;年龄(69.81±13.93)岁,年龄范围为26~97岁,≥60岁占82.73%。70例(63.64%)确诊为丝状真菌感染,其中肺部感染组62例(56.36%),致病菌以曲霉菌为主(87.10%,54/62)。定植/污染组40例(36.36%),均来自呼吸道标本,分离菌株包括曲霉菌(82.50%,33/40)、青霉属等。2组患者性别、年龄、临床表现和影像学表现比较,差异均无统计学意义(P值均>0.05)。2组患者发热比较,差异有统计学意义(χ^2=10.736,P<0.05)。2组标本均主要来源于呼吸科、急诊科和老年科。菌种分布均以曲霉菌属(烟曲霉和黄曲霉)居多,肺部感染组菌种分布更广。肺部感染组主要危险因素为有肺部基础疾病、糖皮质激素使用和糖尿病,肺部感染组较定植/污染组病死率高(35.48%比5.00%,χ^2=12.55,P<0.01)。肺部感染组患者住院期间均使用抗真菌药物治疗,好转40例(64.52%),死亡22例(35.48%)。死亡组患者年龄显著高于存活组(t=4.83,P=0.01),糖皮质激素的使用是死亡主要危险因素(χ^2=8.40,P=0.02)。G试验和GM试验在肺部感染组检测阳性率高于定植/污染组(P值均<0.05)。结论:丝状真菌感染病死率高,通过对丝状真菌感染患者的微生物检验与临床特征研究,有利于提高丝状真菌感染的早期诊断和治疗。Objective To analyze the clinical data and laboratory results of clinical isolates of filamentous fungi,and to improve the understanding of this type of infection.Methods A retrospective study was conducted through collection of the clinical data(including demographic characteristics,clinical manifestations,imaging and microbiological findings)of in-patients with filamentous fungi from Xuanwu Hospital of Capital Medical University between January 2016 to January 2019.The differences between pulmonary infection group and colonization/pollution group,survival group and death group were analyzed,and the risk factors of infection were analyzed.SPSS 20.0 software was used for statistical analysis.Results A total of 110 patients with filamentous fungi were collected,including 70 males and 40 females,with age of 26-97 years(mean 69.81±13.93 years).Among them,≥60 years old accounted for 82.73%.70 cases(63.64%)were diagnosed as filamentous fungal infection,including 62 cases of pulmonary infection(56.36%),and the main pathogens were Aspergillus spp.(87.10%,54/62).40 cases(36.36%)in the colonization/pollution group were from respiratory specimens,and the isolates included Aspergillus spp.(82.50%,33/40),Penicillium,etc.There were no significant differences in gender,age,clinical manifestations and imaging findings between the two groups(all P>0.05).There was significant difference in fever between the two groups(χ^2=10.736,P<0.05).The specimens of both groups were mainly from the department of respiratory,emergency and geriatrics.Aspergillus spp.(Aspergillus fumigatus and Aspergillus flavus)were the dominant species in both groups,and the species distribution in pulmonary infection group was more extensive.The main risk factors of pulmonary infection group were pulmonary basic disease,hormonal use and diabetes.The mortality of pulmonary infection group was higher than that of colonization group(35.48%vs 5.00%,χ^2=12.55,P<0.01).In the pulmonary infection group,40 cases(64.52%)were improved and 22 cases(35.48%)died.The a

关 键 词：真菌 感染 危险因素 定植 半乳甘露聚糖试验 

分 类 号：R446.5[医药卫生—诊断学]