晚期肺癌并发肺部真菌感染的临床分析

Clinical analysis of pulmonary fungal infection in patients with advanced lung cancer

目的：分析并探讨晚期肺癌患者并发肺部真菌感染的临床特点及危险因素。方法：采用回顾性调查方法，分析我科274例晚期肺癌患者中并发肺部真菌感染的58例的临床资料。结果：晚期肺癌患者肺部真菌感染率为21．2％（58／274）。其中，男性36例，女性22例；年龄27～81岁，平均62．7岁；非小细胞肺癌47例，小细胞肺癌11例。真菌类型主要为白色念珠菌（70．7％），其它包括热带念珠菌（5．2％）、光滑念珠菌（3．4％）、隐球菌（15．5％）、毛霉菌（3．4％）和曲霉菌（1．7％）。主要易感因素是年龄≥50岁、有吸烟史、ECOG评分≥2、多周期化疗、化疗联合胸部放疗和Ⅲ度以上白细胞减少。结论：减少易感因素、早期诊断、早期使用抗真菌药物以及加强免疫及支持治疗是降低晚期肺癌真菌感染率的有效措施。

Objective：To analyze and discuss the clinical features and risk factors of pulmonary fungal infection in patients with advanced lung cancer. Methods：Out of 274 investigated patients with advanced lung cancer, clinical records of 58 patients with pulmonary fungal infection were retrospectively analyzed. Results：The rate of pulmonary fungal infection was 21.2% （58/274）. 47 NSCLC and 11 SCLC patients were diagnosed pulmonary fungal infection, 36 males and 22 females. The age was from 27 to 81, with median age of 62.7. The major fungus was candida albicans （70. 7% ）. Other fungus were candida tropicalis（5.2% ）, candida slick （3.4%） , cryptococcus（ 15.5% ） , mold fungus（3.4% ） and aspergillus（ 1.7% ）. The main risk factors were age≥50 years, having smoking history, ECOG≥2, multi-cycles of chemotherapy, chemotherapy plus thoracic radiotherapy,≥3 grade leukopenia. Conclusion：The effective methods to decrease pulmonary fungal infection of patients with advanced lung cancer are reducing risk factors,early diagnosis, early use of anti-fungus agents and adequate immunotherapy and supportive treatment.