肺癌患者肺部真菌感染临床分析

Clinical analysis of lung cancer patients with pulmonary fungal infections

目的分析肺癌患者肺部真菌感染的耐药性及感染的危险因素,为预防与治疗肺癌患者肺部真菌感染提供参考依据。方法回顾性分析2008年3月-2012年3月278例肺癌患者发生肺部真菌感染的临床资料,对真菌培养、药敏试验结果等进行分析,比较感染组52例和非感染组226例患者的性别、年龄、住院时间、使用广谱抗菌药物、使用激素、放化疗及侵入性操作等差异,危险因素分析采用χ2检验。结果医院278例肺癌患者中发生肺部真菌感染率为18.7%,从52例肺癌发生肺部真菌感染患者中分离出真菌57株,其中5例患者为两种真菌同时感染,占9.6%;检出真菌以白色假丝酵母菌为主,占54.4%;57株真菌中有3株对伊曲康唑、氟康唑耐药,耐药率为5.3%,肺癌患者发生肺部真菌感染与住院时间、使用广谱抗菌药物、使用激素、放化疗及侵入性操作等相关(P<0.05)。结论医院肺癌患者合并肺部真菌感染,应尽量缩短患者的住院时间,根据药敏试验合理选择广谱抗菌药物,同时减少激素的应用,避免过度放化疗治疗带来的不良反应,以减少真菌的感染机会。

OBJECTIVE To observe pulmonary fungal infections in lung cancer patients,and analyze its drug resistance and risk factors,for preventing pulmonary fungal infections in patients with lung cancer.METHODS Totally 278 pulmonary fungal patients during Mar.2008 to Mar.2012 were selected,and their fungal culture and drug sensitivity test results were retrospectively analyzed,and genders,age,duration of hospitalization,the use of broad-spectrum antibiotics,use of hormones,radiotherapy,chemotherapy and invasive procedures between infected group with 52 cases and non-infected group with 226 cases were compared.χ2 test was used for the risk analysis.RESULTS The rate of pulmonary fungal infections in 278 cases of lung cancer patients was 18.7%.From 52 cases of lung cancer patients with pulmonary fungal infections,57 strains of fungi were separated,of which 5patients infected with two kinds of fungi,accounting for 9.6%.Candida albicans was the main fungal strain,accounting for 54.4%,followed by Candida tropicalis,C.glabrata,Aspergillus and Candida parapsilosis,accounting for 22.8%,12.3%,7.0 %,1.8% and 1.8%,respectively.In 57 stains of fungi,3stains were resistant to itraconazole and fluconazole,with resistance rate of 5.3%,1stain was resistant to amphotericin B,with resistant rate of 1.8%,and none was found resistant to ketone itraconazole and miconazole.Pulmonary fungal infection was significantly correlated with hospitalization time,the use of broad-spectrum antibiotics,use of hormones,radiotherapy,chemotherapy and invasive procedures（P0.05）,but showed no associations with gender and age.CONCLUSION For lung cancer patients with pulmonary fungal infections,clinical doctors should try to shorten hospitalization periods,make a reasonable choice of broad-spectrum antibiotic susceptibility testing,and reduce the application of hormones to prevent excessive chemotherapy regimens adverse reactions,in order to reduce the chances of fungal infections.