妇产科侵袭性真菌感染患者的诊断和治疗探讨

Characteristics of invasive fungal infections in obstetric and gynecologic patients

目的总结侵袭性真菌感染(IFI)在北京协和医院妇产科手术及肿瘤患者中的诊断和治疗特点,主要关注其分布、病原学特点、高危因素和治疗效果。方法对2003年1月至2009年12月间北京协和医院细菌室及病案科记录的IFI资料行回顾性分析,按诊断标准分为确诊、临床诊断和拟诊病例,按治疗性质分为手术、化疗和恶性肿瘤终末期患者。分析不同IFI患者的分布、病原学特点、高危因素和治疗效果。结果总计220例妇科IFI病例入选,其中确诊、临床诊断和拟诊病例分别为52例、11例和157例。妇产科IFI患者泌尿生殖系感染显著高于全院水平(46.2%vs 18.7%,P<0.001);可能的高危因素包括低白蛋白血症(87.3%)、中性粒细胞减少(52.4%)和放化疗(50.8%);手术、化疗和恶性肿瘤终末期患者的总体治疗有效率分别为100.0%(108/108)、91.6%(87/95)和52.9%(9/17),存在显著差异(P<0.001)。结论妇产科侵袭性真菌感染重症患者多,感染部位分布特殊,易感因素多样,手术及化疗患者中的治疗效果好。

Objective ： To investigate the diagnosis and treatment of invasive fungal infections （IFI） in the patients admitted to the Department of Obstetrics and Gynecology in Peking Union Medical College Hospital （PUMCH）. Methods： The IFI data from the clinical laboratory and Medical Records Department of PUMCH from January, 2003 to December, 2009 were studied retrospectively. The patients were classified by diagnostic criteria as confirmed, clinical-diagnosed or suspected cases, and classified by treatment protocols into surgery, chemotherapy or end-stage of malignant tumors. The distribution, pathogen, risk factors and treatment outcomes of IFIs in these patients were discussed. Results： There were 4,025 cases of IFIs included in our study, with 220 obstetric-gynecologic cases （52 cases confirmed, 11 clinical-diagnosed and 157 suspected）. The incidence of confirmed urinogenital IFIs in obstetric-gynecologic patients was greater than overall incidence of urinogenital IFIs in PUMCH （46.2% vs. 18. 7%, P〈0. 001）. The possible risk factors of IFIs in the obstetric-gynecologic patients were hypoalbuminemia （87.3% in all the confirmed and clinical-diagnosed patients）, neutropenia （52.4%） and chemotherapy or radiotherapy （50.8%）. The treatment effectiveness in the surgical, chemotherapeutic and end stage patients was 100. 0% （108/108）, 91. 6% （87/95）and 52. 9% （9/17）, respectively （P〈0. 001）.Conclusions. The IFI in the patients from the Department of Obstetrics and Gynecology had more se vere cases, diverse risk factors, and special distribution of infection sites. The curative effect was excellent for those receiving surgery or chemotherapy.