肺部真菌感染152例病原谱再评价

A study of 152 cases of pulmonary fungal infection:reevaluation of the microbiological spectra

目的了解肺部真菌感染的病原谱和预后。方法根据欧洲癌症研究和治疗侵袭性真菌感染协作组(EORTC)、美国变态反应和感染性疾病协会真菌病研究组(MSG)2002年制定的定义以及血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准,将北京协和医院2002年1月至2006年6月诊断的152例肺部真菌感染患者按照统一的定义进行重新分组:确诊组38例,临床诊断组24例,拟诊组35例,定植组55例,重新分析病原谱。结果 38例确诊肺部真菌感染的患者中,肺曲霉菌感染占首位(15/38),其次为肺隐球菌感染(13/38),第三为毛霉菌和其他类型丝状真菌,而真正念珠菌肺炎少见,只有2例。临床诊断组曲霉菌和曲霉菌+念珠菌占第1位,而拟诊组以及定植组以单纯念珠菌占首位。临床诊断组病死率为58.3%,高于拟诊组(25.7%)和定植组(16.4%)。拟诊组和定植组"念珠菌肺炎"分别为28例和50例,对这78例"念珠菌肺炎"患者的预后危险因素进行分析后发现,只有急性生理和慢性病评分(APACHEⅡ)与患者的预后有关,而是否抗真菌治疗及使用何种抗真菌药物与预后无关。结论肺部真菌感染以曲霉菌占第1位,其次为隐球菌和毛霉菌,念珠菌肺炎少见。痰标本念珠菌属培养阳性作为"念珠菌肺炎"的诊断标准值得商榷。

Objective To investigate the microbiological spectra and clinical outcome of patients with pulmonary fungal infections. Methods All the cases of clinically diagnosed pulmonary fungal infection from January 2002 to June 2006 were reevaluated according to the definitions of European Organization for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycosis Study Group （EORTC/MSG）, and the etiology of the patients were analyzed. Results Pulmonary fungal disease was classified as proven （ n = 38 ）, probable （ n = 24）, possible （ n = 35 ） and colonization （ n = 55 ）. In the proven group, the most frequently encountered fungi were Aspergillus species （ 15/38 ） , followed by Cryptococcus species （13/38）, Candida species were rare （2/38）. In the probable group, Aspergillus species and Aspergillus species ＋ Candida species were among the most common pathogens; while in the possible group and the colonization group, Candida species were moat frequently encountered. The mortality of patients with probable pulmonary fungal infection （58.3%） was higher than that of patients in the possible group （ 25.7% ） or the colonization group （ 16.4% ） （ P = 0. 001 ）. Univariate analysis showed that only APACHE Ⅱ score was associated with outcome of patients with ＂pulmonary Candida infections＂, and antifungal therapy did not improve the outcome of such patients. Conclusion The moat frequently encountered fungi in patients with pulmonary fungai infections were Aspergillua species, followed by Cryptococcua species. Primary Candida pulmonary infections were rare.