结缔组织病合并侵袭性肺部真菌感染的临床分析

Clinical analysis of patients with connective tissue diseases complicated with invasive pulmonary fungal infections

目的探讨结缔组织病(CTD)合并侵袭性肺部真菌感染(IPFI)的临床表现、病原学特征、易感因素、治疗和预后。方法根据患者血、支气管灌洗及培真菌培养进行抗真菌治疗,并对其方法与转归进行回分析。结果 20例患者确诊2例,临床诊断13例,拟诊5例,17例患者有原发病活动。所有患者均急性起病,发热(80%)常见,可有不同程度的呼吸道症状。有10例患者并发急性Ⅰ型呼吸衰竭。合并有白细胞减少8例(40%),长期使用糖皮质激素治疗17例(85%),免疫抑制剂治疗10例(50%),使用广谱抗生素治疗12例(60%)。侵袭性操作1例(5%)。确诊曲霉菌及肺隐球菌各1例。查出白色念珠菌5例、光滑念珠菌1例及克柔念珠菌2例、毛霉菌1例,有9例患者无病原学资料。所有患者均接受抗真菌药,存活16例(80%),死亡4例(20%),其中3例患者合并有肺部间质纤维化、伴呼吸衰竭,1例患者系延迟抗真菌治疗。结论 CTD合并IPFI感染发生率高;起病急,病情重;临床症状不典型;可引起呼吸衰竭;病原菌检出机率不高,死亡率高,重视患者的宿主因素,积极的早期抗真菌治疗可有效改善预后。

Objective To explore the pathogenic features,clinical spectrum,risk factors,therapy and outcome in patients with connective tissue disease（CTD） complicated with invasive pulmonary fungal infections（IPFI）.Methods A review was performed of 20 CTD patients with IPFI in our hospital between Jan 2006 and Jan 2010.Results The diagnostic status could be classified as follows：2 had confirmed diagnosis,13 had clinical diagnosis,5 had suspected diagnosis.17 patients had active disease.All patients with acute onset,fever（80%） common,may have varying degrees of respiratory symptoms.10 patients had type I respiratory failure.8 patients had leucopenia,17patients had long-term use of corticosteroids,10 patients received immunosuppressants and 12 patients received broad-spectrum antibiotics and 1 patient had invasive operation.The pathogen was Cryptococcus in 1 patient,Aspergillus in 1 patient,Candida albicans in 5 cases,Candida glabrata in 1 case,Candida krusei in 2 cases,Mucor in 1 case.And 9 patients had no pathogen data.Antifungal therapy was used in all patients. Of all cases,16 survived and 4 died.Conclusion Clinicians should be alerted against CTD with IPFI,which is most frequently caused by Candida and usually highly fatal.Early diagnosis and rational treatment could improve the prognosis.