肝病患者合并隐球菌感染的临床和菌株特征分析  

Clinical and Strain Characteristics of Patients with Liver Disease Complicated with Cryptococcus Infection

作　　者：代芳芳[1] 陈铭[1] 康艳芳[1] 孙桂珍[1] 娄金丽[1] 于艳华[1] DAI Fangfang;CHEN Ming;KANG Yanfang;SUN Guizhen;LOU Jinli;YU Yanhua(Department of Clinical Laboratory,Beijing You’an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院检验科,北京100069

出　　处：《标记免疫分析与临床》2024年第7期1207-1210,共4页Labeled Immunoassays and Clinical Medicine

基　　金：科技基础资源调查专项-传染性疾病人群感染病原敏感性与耐药性监测调研(编号:2019FY101212)。

摘　　要：目的分析肝病患者合并隐球菌感染的临床和菌株特征,为该类患者的诊治和预防提供依据。方法分析2013年至2023年就诊于我院的肝病合并隐球菌感染患者的病例信息,对从患者分离出的隐球菌菌株通过基质辅助激光解吸电离飞行时间质谱法进行鉴定并用ITS测序法进行确认,采用多位点序列分型(multi-locus sequence typing,MLST)法对菌株进行分型分析,使用FUNGUS 3对菌株进行抗真菌药物敏感性试验。结果6例肝病合并隐球菌感染的患者中,男性3例,女性3例;年龄48~71岁,平均年龄61.0±8.0岁;肝癌、肝衰竭和肝硬化失代偿期患者各2例;除1例为皮肤软组织感染外,其余为血流、胸腹水、脑脊液和尿液感染。6例患者合并感染的隐球菌均为新型隐球菌格鲁比变种(Cryptococcus neoformans var.grubii),MLST分型均为ST5型。抗真菌药敏实验结果显示6株菌对抗隐球菌一线药物两性霉素B和5-氟胞嘧啶的敏感性为100%,对氟康唑的敏感性为33.3%,中介率为66.7%;6株菌除1株对伊曲康唑为非野生型(non-wild type,NWT)外,其余均为野生型(wild type,WT)菌株,6例患者隐球菌感染后均死亡。结论合并隐球菌感染的肝病患者多为免疫功能严重受损的肝病晚期中老年患者,其感染的隐球菌以新型隐球菌格鲁比变种ST5型为主,对常用抗隐球菌一线药物氟康唑的敏感性较低,单用氟康唑治疗效果差。此类患者合并侵袭性隐球菌感染的情况需引起临床医生重视,对此类患者可进行常规隐球菌感染的筛查,以便及早诊治隐球相关感染。Objective To provide reference basis for diagnosis,treatment and prevention for patients with liver disease complicated with cryptococcal infection though analyzing clinical and strain characteristics of cryptococcal infections.Methods The cases profile of patients with liver disease complicated with cryptococcal infection admitted to our hospital from 2013 to 2023 were analyzed,and Cryptococcus strains isolated from studied patients were identified by stroma-assisted laser desorption ionization time-of-flight mass spectrometry and confirmed by ITS sequencing.Multi-locus sequence typing(MLST)was applied to type and analyze isolated strains.FUNGUS 3 was used for antifungal susceptibility tests.Results Among 6 patients with liver disease combined with cryptococcal infection,3 were male and 3 were female;Age ranged as 48-71 years old,with mean age of 61.0±8.0 years old;There were 2 cases of liver cancer,with liver failure and decompensated cirrhosis separately.Except one case was with soft tissue infection,the other cases were invasive cryptococcal infections.All isolated strains were identified as Cryptococcus neoformans var.grubii,and their MLST classification was ST5.The results of anti-fungal susceptibility test showed that the sensitivity rate of 6 strains to amphotericin B and 5-fluorocytosine was 100%,with the sensitivity rate and the intermediate rate to fluconazole of 33.3%and 66.7%,respectively.All 6 strains were Wild type(WT)except for 1 strain which was non-wild type for itraconazole.All 6 patients died after cryptococcal infections.Conclusion Most of patients with cryptococcal infections are middle-aged and elderly patients with advanced liver disease companied with severely impaired immune function.The isolated strains are mainly Cryptococcus neoformans var.grubii with ST5.The sensitivity rate of Cryptococcus is low to fluconazole,and the treatment effect of fluconazole alone is poor.The status of invasive cryptococcal infection in such type of patients should be paid attention to by clinicians,and ro

关 键 词：肝病 隐球菌感染 多位点序列分型 抗真菌药物敏感性 

分 类 号：R575[医药卫生—消化系统]