侵袭性肺部真菌感染56例临床分析

Invasive Pulmonary Fungal Infection:A Clinical Analysis of 56 Cases

目的探讨侵袭性肺部真菌感染(IPFI)的临床特征。方法回顾性分析2006年1月～2008年1月间我院56例IPFI患者的临床资料,并对患者一般资料、临床表现、辅助检查以及治疗与预后进行分析。结果本组IPFI患者大多起病缓慢,均具有咳嗽、咳痰,为白色泡沫粘痰、胶冻样粘痰或血痰;影像特征为双肺多发斑片状致密影并有融合,累及多个肺叶及肺段,出现炎性实变影最多见;且患者感染前均曾先后应用1～9种抗生素,用药时间较长,平均(15.20±4.26)d;12例用糖皮质激素治疗,平均用药时间(4.35±1.22)d。本组白色假丝酵母菌占66.07%,其次是热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌以及近平滑假丝酵母菌。本组56例肺部真菌感染患者治疗总有效率为82.14%,死亡率为10.71%。结论IPFI起病隐匿,临床表现常无特异性,死亡率高,临床医师应充分了解该病的临床特征,并争取早期明确诊断、治疗。

Objective To invesgate the clinical features of invasive pulmonary fungal infection. Methods The data of 56 cases with invasive pulmonary fungal infection （IPFI） in our hospital from Jan.2006 to Jan. 2008 were collected and the general data,clinical manifestations,anxiliary examination,treatment and prognosis were retrospectively analyzed. Results The cases with IPFI showed a slow onset,cough and expectoration with white foam phlegm,jelly-like phlegm or blood sputum.The image features showed multiple patchy dense shadow of both lungs ,and the multiple lung lobes and segments were involved,with inflammatory consolidation shadow in the most. All of patients received 1 to 9 kinds of antibiotics before infection. The time of medication was longer and the average was （ 15.20 ± 4.26） days. Twelve of 56 cases ever received the treatment of glucocorticoid and the average medication time was（4.35 ± 1.22） days. Candida albieans accounted for 66.07%,followed by eandida tropicalis,eandida smooth,monilia krusei and candida parapsilosis.The total effective rate of treatment was 82.14% and the death rate was 10.71% in the 56 cases. Conclusion The IPFI is characteristic of an oecuh onset,nonspecifie clinical manifestation and a high death rate,and therefore,clinicians must have good understanding of the clinical features of IPFI so as to diagnose and cure it early.