165例老年念珠菌血症患者的临床特征分析及预后评价  

Clinical features and prognosis of elderly patients with candidemia

作　　者：赵越 袁凯旋[2] 叶龙[2] 凌勇[2] 张莉滟[2] Zhao Yue;Yuan Kaixuan;Ye Long;Ling Yong;Zhang Liyan(The Second Clinical Medical College of Guangzhou University of Chinese Medicine;Department of Clinical Laboratory,Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences)

机构地区：[1]广州中医药大学第二临床医学院,广州510120 [2]广东省人民医院/广东省医学科学院检验科,广州510080

出　　处：《重庆医科大学学报》2020年第10期1484-1486,共3页Journal of Chongqing Medical University

摘　　要：目的:分析老年念珠菌血症患者的临床特征及预后情况,为临床诊疗念珠菌血症提供依据。方法:回顾分析2015年1月至2018年12月广东省人民医院被诊断为念珠菌血症的165例相关病例,收集其相关基本资料、诊疗记录、转归情况及实验室指标结果等信息。根据患者住院时间,将其分为2组,即住院天数≤28 d为第1组(104例);>28 d为第2组(61例)。结果:165例老年念珠菌血症患者血培养所分离出的念珠菌主要以白念珠菌(78例)、近平滑念珠菌(40例)、热带念珠菌(25例)为主,主要分布于重症监护室(82例)、内科(25例)、外科(18例)等科室。165例患者均不同程度伴有其他疾病,且病死率为54.5%。比较2组间患者的预后情况,第2组患者的病死率要高于第1组(P<0.05),且未用抗真菌药物治疗的患者病死率高于使用抗真菌药物的患者(P<0.05)。另外,白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、(1,3)-β-D葡聚糖、白介素-6(interleukin-6,IL-6)等指标均有不同程度升高,但对于念珠菌血症的早期诊断无特异性。结论:念珠菌血症的早期临床表现不典型,患者预后受到严重影响,各临床科室均要对其引起重视,完善血培养常规送检,规范使用抗菌药物,做好临床护理工作,以做到对该病的早期诊断与治疗,有效改善患者预后。Objective:To analyze clinical features and prognosis of elderly patients with candidemia,and to provide basis for clinical diagnosis and treatment of candidemia. Methods:A total of 165 cases of candidemia diagnosed in a hospital were collected from January 2015 to December 2018,including the basic data,treatment records,outcomes,and laboratory reports. According to the hospital stay,the patients were divided into two groups:the first group(104 cases)was no more than 28 d,the second(61 cases)was over 28 d. Results:Candida isolated from blood culture of 165 cases were mainly Candida albicans(78 cases),Candida parapsilosis(40 cases),and Candida tropicalis(40 cases),which were mainly distributed in ICU(82 cases),internal medicine(25 cases),and surgery(18 cases). All patients were accompanied by other diseases in different degrees with a mortality of 54.5%. The mortality of the second group was higher than that of the first group(P<0.05),and the mortality of the cases without antifungal drugs was higher than the cases with antifungal drugs(P <0.05). In addition,WBC,PCT,(1,3)-β-D-glucan and IL-6 were increased in varying degrees,however,there were no specificity for the early diagnosis of candidemia. Conclusion:The clinical features of candidemia is not obvious and the prognosis of patients is seriously affected. Clinicians should put a high value on candidemia and improve the routine inspection of blood culture. Antimicrobial agents should be used rationally,in order that early diagnosis and treatment of candidemia can be achieved and the prognosis of patients can be improved effectively.

关 键 词：老年患者 念珠菌血症 临床特征 预后 抗真菌药物 

分 类 号：R379[医药卫生—病原生物学]