肺结核合并真菌感染或定植的临床特点及耐药分析  

Analysis of clinical characteristics and drug resistance of pulmonary tuberculosis complicated with fungal infection orcolonization

作　　者：程玲 Cheng Ling(Department of Infectious Diseases,the People's Hospital of Chibi City,Hubei Province,Hubei Chibi 437300)

机构地区：[1]湖北省赤壁市人民医院感染科,湖北赤壁437300

出　　处：《中国社区医师》2021年第13期23-25,共3页Chinese Community Doctors

摘　　要：目的:探究肺结核(TB)合并真菌感染或定植的临床特点,并分析真菌的耐药情况。方法:2018年3月-2020年3月收治TB患者630例,其中TB合并真菌感染或定植14例,无真菌感染616例,分析其临床特点,同时给予药敏试验,统计真菌的耐药情况。结果:在肺结核合并真菌感染的14例中,纤维空洞型肺结核的感染率明显高于浸润性型与血行播散型,差异有统计学意义(P<0.05)。TB合并真菌感染患者在咯血、咯痰、呼吸困难及湿啰音等症状方面的发生率明显高于无感染的TB,但抗酸染色阳性率明显低于无感染TB患者,TB合并真菌感染病变范围更大,差异有统计学意义(P<0.05)。本次检出真菌14株,均为酵母菌属,其中以白色假丝酵母菌数目最多,其次为热带假丝酵母菌与光滑假丝酵母菌,而克柔假丝酵母菌则较少。药敏试验结果发现,不同真菌对不同抗菌药物的耐药率存在一定的差异,其中,氟康唑与伊曲康唑两种药物在各类真菌中的耐药性普遍较高。结论:相较于无真菌感染的TB患者,TB合并真菌感染或定植患者的症状表现更显著,病变范围更广,临床需针对其真菌耐药情况,合理选择相应的抗菌治疗药物,以此控制病情。Objective:To explore the clinical characteristics of pulmonary tuberculosis(TB)complicated with fungal infection or colonization,and to analyze the drug resistance of fungi.Methods:From March 2018 to March 2020,630 patients with TB were selected,including 14 patients with fungal infection or colonization and 616 patients without fungal infection.The clinical characteristics of TB were analyzed,and the drug sensitivity test was performed to calculate the drug resistance of fungi.Results:In 14 cases of pulmonary tuberculosis complicated with fungal infection,the infection rate of fibrous cavity pulmonary tuberculosis was significantly higher than that of infiltrative pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis,the difference was statistically significant(P<0.05).The incidences of hemoptysis,sputum,dyspnea and wet rale in TB patients with fungal infection were significantly higher than those in TB without infection,but the positive rate of acid-fast staining in TB patients with fungal infection was significantly lower than that in patients without TB infection,the lesion range of TB with fungal infection was larger,the difference was statistically significant(P<0.05).Fourteen strains of fungi were detected,all of which were saccharomyces cerevisiae,of which Candida albicans was the most,followed by Candida tropicalis and Candida glabrata,while Candida albicans was significantly less.The results of drug sensitivity test showed that there were some differences in the resistance rate of different fungi to different antimicrobial agents,among which fluconazole and itraconazole had higher drug resistance in all kinds of fungi.Conclusion:Compared with TB patients without fungal infection,TB patients with fungal infection or colonization often have more significant symptoms and wider range of lesions.It is necessary to select appropriate antibiotics according to their fungal drug resistance in order to control the disease.

关 键 词：肺结核 真菌感染 真菌定植 耐药性 

分 类 号：R521[医药卫生—内科学]