肺部真菌感染的菌种分类及易患因素

Bacterial classification and susceptible factors of lung fungal infection

目的探讨肺部真菌感染的常见菌种、易患因素及临床特点，以加强临床认知。方法回顾性分析2012年11月～2013年11月邯郸市传染病医院77例肺部真菌感染患者的临床资料，对其病史、真菌菌种分类、易患因素、诊治及预后情况进行总结和分析。结果肺部真菌感染的易患因素有慢性肺部疾病及滥用药物等，其中合并慢性阻塞性肺疾病32例（41．56％），肺结核17例（22．08％），2型糖尿病11例（14．29％），低蛋白血症7例（9．09％），开胸术后2例（2．60％），肺癌并发肺部真菌感染3例（3．90％），肝炎后肝硬化并发肺部真菌感染3例（3．90％），血液病并发肺病真菌感染2例（2．60％），长时间应用广谱抗生素49例（63．64％），应用糖皮质激素15例（19．48％）。检出的真菌种类以酵母菌属为主，白色念珠菌47例（61．04％），光滑念珠菌23例（29．87％），热带念珠菌3例（3．90％），曲霉菌4例（5．19％）。确诊后主要应用氟康唑、伏立康唑、5-氟胞嘧啶、两性霉素B等抗真菌治疗，其中55例（71．43％）治愈，20例（25．97％）好转，总体治疗效果较好。结论针对肺部真菌感染的病因、菌种尽早正确诊治是其能否治愈的关键，因此积极综合治疗，提高患者机体免疫力，剔除与肺部真菌感染有关的危险易患因素，及时应用抗真菌药物进行干预，可获得比较满意的治疗效果。

Objective To explore the common strains, susceptible factors and clinical characteristics of pulmonary fun- gal infection, and strengthen clinical cognition. Methods Clinical data of 77 patients with pulmonary fungal infection from November 2012 to November 2013 in the Infectious Diseases Hospital of Handan City were retrospectively ana- lyzed, and the condition of medical history, Strains classification of fungi, risk factors, diagnosis and treatment, progno- sis were summarized and analyzed. Results The susceptible factors of lung fungal infection included chronic lung dis- eases and drug abuse and so on, including 32 cases of chronic obstructive pulmonary diseases （41.56%）, 17 cases of tu- berculosis （22.08%）, 11 cases of type 2 diabetes （14.29%）, 7 cases of hypoalbuminemia （9.09%）, 2 cases of thoraeoto- my （2.60%）, 3 cases of lung cancer and pulmonary fungi posthepatitic cirrhosis complicated with pulmonary fungal in- fection （3.90%）, 3 cases of pulmonary fungi posthepatitic cirrhosis complicated with pulmonary fungal infection （3.90%）, 2 cases of blood disease complicated with pulmonary fungal infection （2.60%）, 49 cases of long time using of broad-spec- trum antibiotics （63.64%）, 15 cases use the glueoeorticoid （19.48%）. The main fungal species was blastocystis, 47 cases of candida albicans （61.04%）, 23 cases of candida glabrata （29.87%）, 3 cases of tropical candida （3.90%）, 4 cases of aspergillus （5.19%）. They were mainly given the antifungal therapy after diagnosis, such as Fluconazole, Voriconazole, 5- Fluorine Cytosine, Amphotericin B, 55 cases （71.43%） were cured, 20 cases （25.97%） were improved, had a good over- all treatment effect. Conclusion Early and correctly diagnosis and treatment according to the strains of pulmonary fun- gal infection is the key to healing, so comprehensive treatment actively, improve the patients immunity, eliminate risk factors associated with pulmonary fungal infection disease, timely application of antifungal drugs to intervene, can ob- tain satisfactory curative effect.