51例肺结核继发肺部真菌感染临床分析

The Clinical Analysis on 51 Cases of Pulmonary Tuberculosis with Secondary Fungal Infection

探讨肺结核继发肺部真菌感染的易感因素、临床特征、诊治方法和预后。应用回顾性调查的方法对51例肺结核继发肺部真菌感染患者的临床资料进行分析。结果56.86%(29/51)的病例患有3种疾病,以肺结核继发真菌感染同时合并其它呼吸系统疾病多见;继发真菌感染的诱因多与应用抗生素和激素、低蛋白血症有关;肺部真菌感染隐袭发病,缺乏特征性临床表现,X线胸片也缺乏特异性;51例真菌感染中致病菌以念珠菌居多;药敏试验以两性霉素B、氟胞嘧啶、氟康唑、伊曲康唑及酮康唑为对照药物,白假丝念珠菌敏感性较好,克柔假丝念珠菌耐药率相对较高。肺结核较易继发真菌感染,应加强抗生素及肾上腺皮质激素的规范应用,以减少真菌感染及其耐药率的发生,有利于结核病控制及减少死亡。

To explore the predisposing factors, clinical features, means of treatment and diagnosis of pulmonary tuberculosis cases with secondary fungal infection. Clinical data of 51 cases of pulmonary tuberculosis with secondary fungal infection were retrospectively analyzed. The results of 56.86% （29/51） cases with three kinds of diseases, and pulmonary tuberculosis with secondary fungal infec- tion and other respiratory diseases was the common disease. The application of antibiotics or hormones and the existence of hypoproteinemia were the predisposing factors of secondary fungal infec- tion. Incidence of pulmonary fungal infection was implicit, all the clinical manifestations and chest xray findings were not specific： The major pathogenic fungus was candida albicans in 51 cases of pulmonary tuberculosis with secondary fungal infection. Drug resistance rates of Amphotericin B, Fluorocytosine, Fluconazole,Itraconazole and Ketoconazole were measured. The antifungal susceptibility of Candida albicails was better and the resistance rates of candida krusei were higher. It is common that fungal infection occurs in pulmonary tuberculosis cases. Standardized application of antibiotic and hormone should be strengthened to reduce the rate of fungal infection and fungal drug resistance, and that will be in favor of tuberculosis control and reducing the death rate.