肺部真菌感染119例临床分析

Clinical analysis of 119 cases of inpatients with fungal infections in the lungs

目的:探讨肺部真菌感染发病原因、临床特点、诊断及治疗。方法:对2004年1月～2008年12月间经微生物学检查证实的119例肺部真菌感染患者的临床资料进行回顾性分析。结果:在119例肺部真菌感染的病例中,90%的病例有基础疾病,原发性肺部疾病48例,神经系统疾病24例,风湿、类风湿及代谢疾病6例,消化系统疾病18例,血液系统疾病11例,泌尿系统疾病5例。继发性肺部真菌感染常见诱发因素,长期使用广谱抗生素69例(57.98%),应用糖皮质激素10例(8.40%),免疫抑制剂14例(11.76%),化疗10例(8.40%),气管切开或插管9例(7.56%),吸毒2例(1.68%),其他5例(4.20%)。感染的病原菌以白色念珠菌、热带假丝念珠菌、新型隐球菌、曲霉菌为主。在临床上发热者有76例(63.87%),白细胞增高者有92例(77.31%)。单纯用大扶康、两性霉素B治疗者分别为63、11例,其余病例均采取联合治疗。治愈87例,占73.11%;好转4例,占3.36%;未愈5例,占4.20%;死亡23例,占19.32%。近年来肺部真菌感染发病率明显增高,2004年1月～2007年1月41例,占34.45%;2007年2月～2008年12月78例,占65.54%。结论:近年来肺部真菌感染有逐年增加的趋势,这与长期大剂量广谱抗生素、大剂量糖皮质激素及免疫抑制剂的应用、化疗等密切相关,也与医院检测条件及技术有关。

Objective：To discuss the etiology,clinical characteristics,diagnosis and treatment of lung fungi infection.Methods：The medical date which performed in 119 patients with lung fungi infection who were confirmed by pathogens examination from January 2004 to December 2008 were retrospectively analyzed.Results：90% of the 119 patients of lung fungi infection were upon different underlying diseases.Among them,48 cases were primary lung diseases,24 cases were neuroses,6 cases were endocrinopathy and rheumatosis,18 cases were gastroenteropathy,11 cases were hemopathy,and 5 cases were nephropathy.Long-term applications of antibiotic was 69 cases（57.98%）,glucocorticoid was 10 cases（8.4%）,im munosuppressant was 14 cases（11.76%）,chemotherapy was 10 cases（8.4%）,endotracheal tubes from intubated patients was 9 cases（7.5%）,opium eating was 2 cases（1.68%） and others 5 cases（4.2%） were the inducing agents.The pathogens were mainly Candida albicans,C.tropicanlis,Cryptococus neoformans and Aspergicllus.Among them were 76 cases（63.87%） with fever and 92 cases（77.31%） with leukocyte heightening.Fluconazole was applied to 63 cases,amphotericin B was ap plied to 11 cases,and the others applied combined therapy.87 cases（73.11%） were healed,4 cases（3.36%） got better,5 cases（4.20%） had no efficacy,and 23 cases（19.32%） died.Recently lung fungi infection increased obviously：from January 2004 to January 2007 the cases were 41（34.45%）,and from February 2007 to December 2008,the cases were 78（65.54%）.Conclusion：Recently lung fungi infection has an increasing tendency.The infection is specifically related with receiving longterm antibiotics,hormones,immunosuppressant and chemotherapy.It is also related with hospital detective terms and tech niques.The mortality rate of lung fungi infection is high presently.