肿瘤患者肺部侵袭性真菌感染特征及病理学特征分析

Pulmonary invasive fungal infections and their pathological features in patients with a tumor

目的探究肿瘤患者肺部侵袭性真菌感染及病理学特征,为临床疾病诊治提供参考。方法选取65例肺部侵袭性真菌感染的肿瘤患者为研究对象,所有患者均接受CT影像学诊断以及病原学检查。采用K-B法分析真菌耐药性。结果 65例肿瘤患者发生侵袭性真菌感染,CT影像学特征为结节或肿块影、空洞、晕征、新月征、洞中球征、淋巴结肿大、肺气腔实变、炎性浸润、胸腔积液的患者数分别为17、14、10、8、6、4、3、2和1例。共分离74株真菌,其中白色假丝酵母菌、热带假丝酵母菌、曲霉菌属、光滑假丝酵母菌、克柔假丝酵母菌、隐球酵母菌属、其他真菌数分别为36、13、11、7、3、1和3株。白色假丝酵母菌对氟康唑、伊曲康唑、伏立康唑、两性霉素B、卡帕芬净的耐药率分别为2.78%、5.56%、2.78%、2.78%和0.00%;热带假丝酵母菌耐药率分别为7.69%、23.08%、7.69%、15.38%和0.00%;曲霉菌属耐药率分别为100.00%、18.18%、9.09%、9.09%和0.00%。咳嗽患者41例(63.08%),发热患者34例(52.31%),咳痰患者22例(33.85%),咯血患者16例(24.62%),呼吸困难患者18例(27.69%)。8例(12.31%)没有上述呼吸道症状的患者,发现肺内单发结节。10例(15.38%)患者发生肺内湿啰音,2例(3.08%)发生干啰音。结论肿瘤患者肺部侵袭性真菌感染类型以白色假丝酵母菌居多,CT影像学特征常见结节或肿块影。患者常见临床特征为咳嗽、发热、咳痰等。

Objectives To investigate pulmonary invasive fungal infections and their pathological features in patients with a tumor in order to provide a reference for prevention and treatment of such infections in clinical settings. Methods Subjects were 65 patients with a tumor who were also infected with a pulmonary invasive fungus.All patients underwent a CT scan and pathogen testing.The K-B method was used to analyze the drug resistance of fungi. Results Sixtyfive patients with a tumor developed a pulmonary invasive fungal infection.Imaging features were a nodule or mass in 17 patients,a cavity in 14,a halo in 10,an air-crescent sign in 8,a hole-in-a-ball sign in 6,lymph node enlargement in 4,airspace consolidation in 3,inflammatory infiltrates in 2,and pleural effusion in 1.Seventy-four strains of fungi were isolated,including 36 strains of Candida albicans,13 strains of C.tropicalis,11 strains of Aspergillus,7 strains of C.glabrata,3 strains of C.krusei,1 strain of Cryptococcus,and 3 strains of other fungi.C.albicans was resistant to fluconazole at a rate of 2.78%,to itraconazole at a rate of 5.56%,to voriconazole at a rate of 2.78%,to amphotericin B at a rate of 2.78%,and to caspofungin at a rate of 0.00%.C.tropicalis was resistant to fluconazole at a rate of 7.69%,to itraconazole at a rate of 23.08%,to voriconazole at a rate of 7.69%,to amphotericin B at a rate of 15.38%,and to caspofungin at a rate of 0.Aspergillus was resistant to fluconazole at a rate of 100.00%,to itraconazole at a rate of18.18%,to voriconazole at a rate of 9.09%,to amphotericin B at a rate of 9.09%,and to caspofungin at a rate of 0.Forty-one patients had a cough（63.08%）,34 had a fever（52.31%）,22 had expectoration（33.85%）,16 had hemoptysis（24.62%）,and 18 had dyspnea（27.69%）.Eight patients（12.31%）did not have the aforementioned respiratory symptoms but all had single nodules in the lung.Ten patients（15.38%）had moist rales（15.38%）and 2（3.08%）had rhonchi. Conclusion The fungus infected the lungs of patients with a tumor was mainly C.albicans,and a common feature of CT imaging was a nodule or mass.Common clinical manifestations included a cough,a fever,and expectoration.