老年人侵袭性真菌病的临床病理分析

Clinical and pathological analysis of autopsy-confirmed invasive fungal disease in elderly patients

目的 对尸检病理确诊的老年人侵袭性真菌病（IFD）病例进行临床与病理对比分析,了解IFD患者的临床和病理特点. 方法 回顾分析1984-2014年北京医院经尸检病理确诊的IFD病例18例,分析资料记载的相关危险因素、临床表现、病原学检查、影像学表现及病理结果等特点. 结果 18例尸检病理确诊的IFD患者均为男性,平均年龄（83.7±7.2）岁;患者均有1种以上的IFD危险因素,其中14例（77.8％）患有不同来源的恶性肿瘤;病原分布以毛霉感染最为常见（6例）,其次是曲霉（4例）、念珠菌（4例）、隐球菌（2例）;在受累脏器中,肺脏受累最为常见13例（72.2％）,其次为消化道.对血管的侵袭是真菌感染的重要病理特点,可表现为血管炎、血栓或菌栓栓塞等.14例患者死亡与真菌感染相关,其中4例直接死于真菌感染侵袭血管导致的大出血.结论 老年IFD患者中,恶性肿瘤是重要的因素;对血管的侵袭性是真菌感染的重要特点.

Objective To compare and analyze clinical and pathological data of autopsyconfirmed invasive fungal disease （IFD） in elderly patients in order to achieve a better understanding of the clinical and pathological characteristics of IFD.Methods A total of 18 cases of IFD were diagnosed by autopsy from 1984 to 2014 at Beijing Hospital.Clinical and pathological data of IFD,including risk factors,clinical manifestation,X-ray and pathological characteristics,were analyzed retrospectively.Results The 18 cases were all male wvith an average age of （83.7±7.2） years and each patient had at least one risk factor for IFD.Of them,14 patients （77.8%） suffered malignancies of various origins.With respect to the pathogens,Mucor （6 cases） was the most common one,followed by Aspergilla （4 cases）,Mycotoruloides （4 cases） and Cryptococci （2 cases）.The lung was the most frequently implicated organ wvith 13 cases （72.2%）,followed by the gastrointestinal tract.Vascular erosion was an important pathological characteristic of fungal infection,whose presentations included vasculitis,hemorrhage and embolism in tissues and organs.14 patients died from fungal infection-related causes,of which.massive hemorrhage as a result of vascular erosion by fungal infection was responsible for four patients＇ deaths.Conclusions Malignancies are an important risk factor for invasive fungal disease in elderly patients.Vascular erosion is a significant character of fungal infection.