1980-2020年我国报告的310例毛霉菌病病例分析  

Mucormycosis:analysis of 310 cases reported in China from 1980 to 2020

作　　者：孙军平[1] 汪建新[1] 张明月[1] 韩欣洁 张歆刚[1] Sun Junping;Wang Jianxin;Zhang Mingyue;Han Xinjie;Zhang Xingang(Department of Respiratory and Critical Care Medicine,the Eighth Medical Center of PLA General Hospital,Beijing 100193,China)

机构地区：[1]解放军总医院第八医学中心呼吸与危重症医学部,北京100193

出　　处：《国际呼吸杂志》2022年第4期279-284,共6页International Journal of Respiration

摘　　要：目的分析1980年至2020年文献报道的中国发生的毛霉菌病病例流行病学、易感因素及其预后。方法本研究为横断面研究。收集自1980年至2020年中国知网、万方数据库、维普生物医学、中国医院知识仓库、中国生物医学文献数据库、中华医学会期刊全文数据库6个中文数据库中中文文献报道的中国发生的毛霉菌病病例310例, 收集其年龄、性别、发病时间、基础疾病、感染部位、确诊手段、治疗方法及其预后, 并对其流行病学进行统计学分析。结果 40年间报道毛霉菌病病例共计310例, 病死率为42.9%(133/310)。报道人数时间分布呈上升趋势, 其中1980-1990年间18例, 死亡10例(55.6%), 2011-2020年间达到152例, 死亡51例(33.6%)。59.7%的病例曾经有长期使用广谱抗生素的情况, 且其所占的比例逐年升高。糖尿病是毛霉菌感染常见的基础疾病, 所占比例为33.5%(104/310), 是毛霉菌病患者死亡的独立危险因素(OR=2.22, 95%CI:1.02~4.83)。肺是毛霉菌常见的感染部位, 占所有患者的41.0%(127/310), 且肺部空洞多发(41/127, 32.3%), 肺毛霉菌感染患者病死率达50.4%(64/127)。鼻窦毛霉菌感染占21.0%(65/310), 病死率为41.5%(27/65)。两性霉素B及其脂质体治疗可降低患者死亡的风险(OR=0.33, 95%CI:0.17~0.64)。手术亦可降低患者的病死率(OR=0.14, 95%CI:0.06~0.32)。结论近年来毛霉菌的发病人数较前明显增加, 广谱抗生素的大量应用、糖尿病以及激素的使用等都是毛霉菌感染的危险因素。毛霉菌病患者的病死率受其基础疾病、感染部位、治疗手段等多种因素的影响。手术和两性霉素B及其脂质体治疗是改善毛霉菌病患者预后、降低其病死率的有效治疗手段。Objective To analyze the epidemiology,predisposing factors,and prognosis of mucormycosis,which were reported from 1980 to 2020 in China.Methods This was a cross-sectional study.A total of 310 cases of mucormycosis reported from 1980 to 2020 were collected by using the following six databases:the Chinese National Knowledge Infrastructure,Wanfang Data,VIP Information for Biomedical Engineering and Clinical Medicine,China Hospital Knowledge Database,China Biology Medicine Disc,and Chinese Medical Association Full-text Database.The data collected include age,gender,onset time,underlying diseases,infection site,diagnostic method,treatment method and prognosis of the patients,and statistical analysis of the epidemiology was performed.Results A total of 310 cases of mucormycosis were reported over the 40-year period with a mortality rate of 42.9%.The reported incidence showed an increasing trend annually.Among the cases,59.7%had a long-term history of broad-spectrum antibiotic application,and this proportion increased annually.Diabetes was a common underlying disease,accounting for 33.5%of the cases,and was an independent risk factor for the death of patients with mucormycosis(OR=2.22,95%CI:1.02-4.83).Pulmonary infection was common and found in 41.0%of all patients(127/310),with a mortality rate of 50.4%(64/127).Sinus infections accounted for 21%of cases,with a mortality rate of 41.5%.Amphotericin B and its liposomes reduced the risk of death in the patients(OR=0.33,95%CI:0.17-0.64).Surgery also reduced the mortality rate(OR=0.14,95%CI:0.06-0.32).Conclusions In the recent years,the incidence of mucormycosis has significantly increased.The extensive application of broad-spectrum antibiotics,diabetes and the use of hormones were risk factors for mucormycosis.The mortality rate was affected by a variety of factors,including the underlying diseases,infection site and treatment.Surgery and amphotericin B with its liposomes were effective treatments that can improve the prognosis and reduce mortality in patients with mucormyc

关 键 词：毛霉菌病 糖尿病 肺 鼻窦 两性霉素B 手术 

分 类 号：R519[医药卫生—内科学]