系统性红斑狼疮患者深部真菌感染病原学分析与临床治疗研究

Etiological analysis and clinical treatment study of deep fungal infections in patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮继发深部真菌感染病原学诊断及抗菌药物应用,以期降低抗菌药物耐药性,提高临床诊治水平。方法选取2009年1月-2014年1月86例系统性红斑狼疮患者为研究对象,对其中并发深部真菌感染的患者进行病原菌和耐药性分析,采用SPSS13.0软件进行统计分析。结果 86例系统性红斑狼疮患者发生深部真菌感染16例,共培养出真菌37株,其中肺部有15株占40.54%,胃肠道7株占18.92%,其他15株占40.54%;检出真菌以白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌、新型隐球酵母菌为主,占78.38%;所有真菌均对两性霉素B、伏立康唑耐药性较低,在0~25.00%,新型隐球酵母菌对氟胞嘧啶、甲帕霉素耐药率较低,均为16.67%,光滑假丝酵母菌对球红霉素耐药率为12.50%,对其他抗真菌药物耐药率均较高,在50.00%~83.33%。结论系统性红斑狼疮继发深部真菌感染主要是条件致病菌,应用敏感抗菌药物及重视预防可提高预后。

OBJECTIVE To investigate etiological diagnosis of deep fungal infections of systemic lupus erythematosus and the application of antibiotics so as to decrease the drug resistance of antibiotics and improve the clinical diagnosis.METHODS From Jan.2009 to Jan.2014,a total of 86 cases of patients with systemic lupus erythematosus were chosen as study objects.Among them,patients with concurrent deep fungal infections were selected and pathogenic analysis and drug resistance test were conducted to them.All data were analyzed by SPSS 13.0software.RESULTS Totally 16 patients were found to be deeply infected by fungal in the all 86 patients with systemic lupus erythematosus.And 37 strains of fungi were cultured,including 15strains（40.54%）from lung,7strains（18.92%）from gastrointestinal tract,and the other 15 strain,accounting for 40.54%.The fungi detected were dominated by Candida albicans,Candida glabrata,Candida tropicalis,and new Cryptococcus,accounting for78.38% of all pathogens;all fungi were of low drug resistance rate to amphotericin B and voriconazole with the rate of 0~25%,while the new yeast Cryptococcus were less resistant to flucytosine and rapamycin with the drug resistance rate of 16.67%.The drug resistance rate of C.glabratato erythromycin was 12.5%.While to other antifungal drugs,the drug resistance rate was between 50.00%and 83.33%.CONCLUSIONOpportunistic pathogens were the main reason for systemic lupus crythematosus.The application of sensitive antifungal drugs and the focus on prevention can improve the prognosis.