8例自身免疫病患者侵袭性真菌感染临床分析

Clinical Analysis of Invasive Fungal Infection In 8 Patients With Autoimmune Diseases

目的分析8例自身免疫病患者合并侵袭性真菌感染(IFI)的临床特征,主要包括宿主因素、临床特点、抗真菌治疗及疗效。方法回顾性分析8例侵袭性真菌感染的临床资料。结果长期使用糖皮质激素、免疫抑制剂是导致IFI的宿主因素。IFI中肺部感染最多见,占87.5%(7/8例)。7例肺部真菌感染病例均伴有发热、呼吸困难及低氧血症。肺部真菌感染患者均出现肺部影像学改变,其中典型的"光晕征"或"新月征"占42.9%(3/7例)。上述临床特点均不具备特征性、尽快获得病原学证据比较困难。综合上述临床特点、按照中国IFI诊断指南是临床诊断IFI的主要方法。本研究中抗真菌治疗总有效率(痊愈+显效)75%,临床疗效与患者免疫状态有关。抗真菌治疗药物安全性良好。结论早期诊断IFI困难,对真菌感染进行临床分层诊治是自身免疫性疾病发生IFI的重要诊治模式。

Objective Eight IFI patients with autoimmune disorders were analyzed on host factors and radiological, clinical, and therapeutic data and its efficacy. Methods Retrospective analysis was performed on clinical data of 8 IFI patients with autoimmune disorders. Results Increased risk for IFI of patients was due to use of glucocorticoids and immunosuppressive agents for a long period. Pulmonary IFI, as one of the most common complications, accounted for 87.5% in all IFI patients. The common clinical manifestations including fever, anorexia, hypoxia and abnormal radiological changes in lung were important indicators for clinical observations and evaluating therapeutic efficacy. 7 pulmonary IFI patients were all complicated with fever and anorexia. Pulmonary IFI patients all presented abnormal radiological characters, and typical halo sign and/or air crescent sign in lung CT accounted for 42.9%. All the above clinical manifestations were nonspecific, and detection of microorganisms is relatively difficult in early stage. The primary diagnosis of IFI depends on the integrated clinical data according to diagnostic criteria and therapeutic principle of invasive fungal infection in hematological diseases or malignant tumors (2007) made in China. Total efficacy rate was 75% in IFI patients with anti-fungus management which had relatively good safety, and better efficacy was related to the improvement of immunologic status. Conclusions It is difficult to diagnose IFI as early as possible. Stratified diagnosis and therapy was an important pattern for IFI patients with autoimmune disorders.