霉菌性食管炎40例临床分析

Clinical analysis of 40 cases of fungal esophagitis

目的分析真菌性食管炎内镜下及临床发病特点,总结诊断、治疗经验并提高对真菌性食管炎的认识。方法收集复旦大学附属中山医院闵行分院内镜中心2016年1月至2018年1月发现的40例真菌性食管炎患者相关资料,进行回顾性分析,所有病例均行胃镜检查和病原学检查,病理结果均由病理医师确诊。结果40例均确诊为真菌性食管炎。其中,男28例(占70.0%),女12例(占30.0%),男性多于女性,年龄分布在32~88岁之间(中位年龄64岁),30~50岁11例(27.5%),50~70岁20例(50.0%),>70岁9例(22.5%)。真菌性食管炎主要症状包括上腹部不适(25.0%)和反酸(35.0%),内镜下分型主要集中在Ⅱ型(67.5%),可合并多种基础疾病,最常见为糖尿病(40.0%),其次为溃疡性结肠炎(25.0%)。结论真菌性食管炎以男性多见,确诊的主要方法为内镜表现加上病原学检查,最常见的致病菌是白色念珠菌,因此,一线治疗为氟康唑,在进行抗真菌治疗的同时需治疗合并的基础疾病,质子泵抑制剂的应用尚缺乏共识,对于久治不愈者,应警惕HIV感染可能。

Objective To analyze the clinical,pathological and endoscopic features of fungal esophagitis,summarize diagnostic and treatment experienceand improve the understanding of fungal esophagitis.Methods A retrospective analysis of 40 cases of fungal esophagitis patients were conducted.All cases were diagnosed in Endoscopy Center of Minhang Branch of Zhongshan Hospital Affiliated to Fudan University from January 2016 to January 2018.Moreover,gastroscope and etiological examination were performed,and the pathology results have been confirmed by pathologists.Results The 40 patients were diagnosed with fungal esophagitis.There were 28 males(70.0%)and 12 females(30.0%),and males were more than females.Tthe age ranged from 32 to 88 years old(median age:64 years old).Among these cases,30-50 years old patients accounted for 27.5%(11 cases),50-70 years old patients accounted for 50.0%(20 cases)and>70 years old accounted for 22.5%(9 cases).The main symptoms of fungal esophagitis included upper abdominal discomfort(25.0%)and acid reflux(35.0%).Endoscopic classification was mainly concentrated in typeⅡ(67.5%),and most of the patients were commonly with diabetes(40.0%)and followed by ulcerative colitis(25.0%).Conclusion Fungal esophagitis is more common in men.Endoscopic findings plus pathogenic examination is the main method to diagnose this disease.The most common pathogen is Candida albicans.Therefore,the first-line treatment is fluconazole,which is used for antifungal treatment.At the same time,it is necessary to cure the combined diseases.There is still a lack of consensus on the application of proton pump inhibitors for fungal esophagitis patients.For those who have not fully recovered after a long time treatment,physicians should be alert to the possibility of human immunodeficiency virus(HIV)infection.