艾滋病合并马尔尼菲青霉病感染率调查和实验室检查及药敏分析

Infection Rate of Acquired Immune Deficiency Syndrome Disease Combined with Penicillium Marneffei Laboratory Test Results and Analysis of Susceptibility

目的探究艾滋病(AIDS)合并马尔尼菲青霉病(PSM)的感染率,以及常规实验室检查结果和5种抗真菌药物对马尔尼菲青霉菌(PM)的体外抗菌活性。方法 2006年1月2009年11月间确诊AIDS患者326例,从其血液、骨髓培养出65株PM,检测该65例患者的血常规、肝功能和肾功能,并对20株酵母相PM进行体外药敏进行分析。结果 AIDS合并PSM的感染率为19.94%;外周血常规:WBC<4.0×109/L者48例,HB<100g/L者51例,PLT<100×109/L者46例。肝功能检查:ALT>40U/L者49例,AST>40U/L者51例,GGT>60U/L者44例,ALP>150U/L者36例,ALB<35g/L者53例,A/G倒置者50例。肾功能检查:BUN>7.2mmol/L者9例,Cr>150μmol/L者4例。20株酵母相PM对5-氟胞嘧啶(5FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分别为75%、90%、80%、90%、90%。结论 AIDS合并PSM感染率较高;患者感染后外周血WBC、HB、PLT通常低于正常人,肝功能多表现异常,肾功能的改变较少;对PM的治疗以AMB、ITR、VRC为首选。

Objective To find out the infection rate of acquired immune deficiency syndrome （AIDS） disease combined with Penicillium marneffei （PSM） and the conventional laboratory test results and five antifungal agents against Penicillium marneffei （PM） in vitro antibacterial activity. Methods In this hospital from January 2006 to November 2009 among 326 cases of AIDS, 65 cases were found with PM from their blood and bone marrow, and their routine blood test, liver function and kidney function were determined, and 20 strains of yeast-phase Penicillium marneffei in vitro susceptibility were analysed. Results AIDS combined with Penicillium marneffei infection rate was 19.94%; peripheral blood routine test： WBC4.0×10~9/L in 48 cases, HB100 g/L in 51 cases, PLT100×10~9/L in 46 cases. Liver function tests： ALT40 U/L in 49 cases, AST40 U/L in 51 cases, GGT60 U/L in 44 cases, ALP150 U/L in 36 cases, ALB35 g/L in 53 cases, A/G inversion in 50 cases. Renal function test： BUN7.2 mmol/L in 9 cases, Cr150 μmol/L in 4 cases. The sensitivity rate of 20 strains of yeast-phase Penicillium marneffei to flucytosine （5FC）, amphotericin B （AMB）, fluconazole （FCA）, itraconazole （ITR） and voriconazole （VRC） were 75%, 90%, 80%, 90% and 90%. Conclusion The AIDS combined with PSM is at a relatively high proportion; their peripheral blood WBC, HB, PLT is usually lower than normal people, abnormal liver function is often observed, and changes of kidney function is rare. First choice of antibacterials for PM treatment is AMB, ITR, and then VRC.