肿瘤内科医院肺部真菌感染69例临床分析

Clinical analysis of pulmonary fungal infections in 69 tumor patients

目的对肿瘤内科医院肺部真菌感染的临床资料进行总结分析,以提高治疗效果。方法回顾性分析医院2002年9月-2011年3月收治的69例肿瘤患者真菌感染的诱因、诊治及预防情况。结果共收治肿瘤患者1623例,肿瘤合并真菌感染患者69例,总感染率为4.25%;主要发生在>50岁患者,占89.9%;69例患者中短期接受放化疗治疗者28例,手术者14例,广谱抗菌药物应用61例,长期接受免疫抑制剂治疗者3例,接受糖皮质激素治疗者10例;自住院后出现真菌感染症状时间为9～31d,平均时间为(12.1±5.3)d;病例中基础病为:原发性肺癌37例感染率为4.56%,转移性肺癌10例为9.34%,纵隔肿瘤2例为2.32%,食管癌14例为4.50%,其他肿瘤6例为1.94%;经单因素方差分析显示,放疗与肺部真菌感染关系密切,放化疗与单一放疗感染无差异;69例患者共检出7种菌株,治疗结果,其中2例死于真菌性肺炎,其余67例中,54例痰菌转阴,治愈38例,复发5例。结论肿瘤内科住院患者应注重对肺部真菌感染的引发因素进行预防,必要时进行药物预防。

OBJECTIVE To analyze and summarize the clinical data of pulmonary fungal infections in department of oncology so as to improve treatment effect. METHODS A retrospective analysis of 69 cancer patients who were treated in the hospital from Sep 2002 to Mar 2011 was performed, the predisposing factors, the diagnosis and treatment and the prevention were investigated. RESULTS Of 1623 tumor patients who were enrolled in hospital for treatment, fungal infections occurred in 69 tumor patients with the total infection rate of 4.25%1 the patients with 50 years of age or older was the major population, accounting for 89. 9%; of 69 patients, there were 28 patients who accepted the short term radiotherapy and chemotherapy, 14 patients who underwent surgery, 61 patients who used broad-spectrum antibiotics, 3 patients who received long-term immunosuppressive therapy, and 10 patients who received glucocorticoid treatment; the fungal infection symptoms occurred within 9--31 d after discharged from the hospital, the average time was （12.1 ± 5.3）d; the underlying diseases in those cases were as follows：37 cases with primary lung cancer, 10 cases with metastatic lung cancer, 2 cases with mediastinal tumor, 14 cases with esophageal cancer, and 6 cases with other tumor; univariate analysis showed that radiotherapy was closely related to the pulmonary fungal infections, and there was no difference between the chemoradiotherapy and the single radiotherapy~ there were totally 7 species of bacteria isolated from 69 patients among which 2 patients died of fungal pneumonia, and of other 67 cases, 54 cases were sputum negative, 38 cases cured, 5 cases recurrence. CONCLUSION The hospitalized tumor patients should focus on the prevention of predisposing factors for the pulmonary fungal infections,if necessary, antibiotics applied.