慢性阻塞性肺疾病继发侵袭性真菌感染的特点及抗真菌药物的治疗分析

Characteristics of Invasive Fungal Infections Secondary to COPD and Its Treatment with Antifungal Drugs

目的分析慢性阻塞性肺疾病继发侵袭性真菌感染的特点及抗真菌药物的治疗效果。方法回顾性分析浙江省桐庐县中医院重症监护室(ICU)2008年1月—2012年1月收治的43例慢性阻塞性肺疾病继发侵袭性真菌感染患者的临床特点及真菌学特点。根据用药不同分为氟康唑组18例和米卡芬净组25例,比较两组的治疗效果和不良反应发生情况。结果 43例患者真菌感染以侵袭肺部为主,以白色念珠菌(42.9%)和曲霉菌(25.0%)为主。米卡芬净组有效率为66.7%(18例),高于氟康唑组有效率44.4%(8例)(χ2=10.05,P<0.05)。米卡芬净组未见严重不良反应。结论慢性阻塞性肺疾病患者继发侵袭性真菌感染多为肺部感染,白色念珠菌和曲霉菌感染多见,米卡芬净较氟康唑是更为安全有效的抗真菌药物。

Objective To analyze the features of invasive fungal infections （IFI） secondary to chronic obstructive lung disease （COPD）, and to compare the clinical therapeutic effect of micafungin and fluconazole. Methods A total of 43 patients with COPD complicated by IFI treated in the intensive care unit （ICU） of our hospital from January 2008 to January 2012 were included in our study. Their clinical data were reviewed retrospectively. Based on their medication, the cases were divided into micafungin group （n =25） and fluconazole group （n = 18）. Patients were given micafungin or fluconazole through intravenous infusion, and the efficacy as well as the occurrence of adverse drug reactions in the two groups were reviewed and ana- lyzed. Results In all 43 cases, pulmonary fungal infection was predominant, and the most common fungi were Candida albi- cans （42.9%） and aspergillus （25.0%）. The effective rate in micafungin group （66. 7% ） was significantly higher than that in fluconazole group （44. 4% ） （ x2 = 10. 05, P 〈 0. 05 ）. There were no adverse reactions in micafungin group, while there were 3 cases of liver dysfunction in fluconazole group. Conclusion IFI secondary to COPD happened mostly in lung. The ma- jority of fungi identified in patients with COPD complicated by IFI were Candida albicans and aspergillus. Micafungin is superior to fluconazole in both efficacy and safety in the treatment of IFI in ICU.