肺毛霉菌病25例临床高危因素特征及预后分析

Clinical high risk factors and prognosis of 25 pulmonary mucormycosis cases

目的分析了解肺毛霉菌病患者预后相关的临床高危因素特征及治疗方案。方法回顾性分析2009年1月至2017年12月浙江大学医学院附属第一医院收治的25例肺毛霉菌病患者的高危因素、临床特征、治疗方案及预后情况。结果25例肺毛霉菌病患者单个高危因素对预后差异无统计学意义，多因素logistic回归分析可见抗真菌药物暴露史与患者预后相关（P=0．046）。4例接受手术治疗的患者均好转，8例未接受抗毛霉菌治疗的患者均死亡。13例接受抗毛霉菌药物治疗患者中7例有效，有效率54％。手术治疗组患者病死率低于未手术组（P=0．026）；接受抗毛霉菌药物治疗组患者预后优于未接受抗毛霉菌药物治疗组（P=0．022）；单用两性霉素B、泊沙康唑及两药联合组问预后无统计学差异。结论肺毛霉菌病好发于血液系统恶性肿瘤、实体器官移植后免疫抑制、长期糖皮质激素使用及糖尿病患者。接受手术治疗患者愈后更佳。接受两性霉素B和（或）泊沙康唑抗毛霉菌治疗可改善患者愈后。

Objective To analyze high risk factors, therapeutic regimen and prognosis of patients with pulmonary mucormyeosis. Methods A retrospective analysis was performed on the clinical data of 25 patients who were diagnosed as pulmonary mucormycosis in the First Affiliated Hospital, School of Medicine, Zhejiang University,between January 2009 and December 2017. Results Univariate analysis revealed that no risk factor had significant effect on prognosis of these 25 cases, while multivariate logistic regression analysis confirmed that the exposure to antifungal drugs was correlated to worse prognosis （P = 0.046）. All 4 patients who had received surgical lesionectomy were cured, and 8 patients who had not received any therapy targeted to mueormycosis were all dead. Seven of 13 patients received antifungal drug to mucormyeosis were effective, with an effective rate of 54.0%. The mortality rate of the operative group was lower than that of the non-operative group （P = 0. 026 ）, and the prognosis of the patients received drug treatment was better than patients without treatment（P = 0. 022 ）. There was no significant difference in the prognosis between groups of single drug or combination of amphoteriein B and posaconazole. Conclusions Pulmonary mucormycosis is more likely to occur in patients with tumor of the hematopoietic and lymphoid tissues, immunosuppression after solid organ transplantation, long-term glucoeorticoid usage and diabetes. Surgical lesionectomy can improve the survival rate, and the treatment with amphotericin B and/or posaconazole can also improve the prognosis of the patients.