侵袭性念珠菌感染在免疫力低下人群中的流行病学和治疗进展

Advances in epidemiology and treatment of invasive Candida infection in the immunocompromised population

随着器官移植等现代医学手段的大量开展、广谱抗生素和免疫抑制剂的广泛应用以及人类寿命的延长,免疫力低下人群的数量不断增多。侵袭性真菌感染在此类人群中的发病率和死亡率不断增高,已成为恶性肿瘤、器官移植等致死的直接原因。念珠菌是侵袭性真菌感染的首要致病真菌,它可侵入人体皮下组织、黏膜和全身各组织、器官,进而在血液中播散。念珠菌感染主要表现为念珠菌血症和深部念珠菌病,常预后不佳。目前,针对免疫力低下人群侵袭性念珠菌(invasive Candida,IC)感染的治疗方法仍以抗真菌感染为主,药物治疗是有效途径之一。临床常规抗真菌药物包括多烯类、唑类和棘白菌素类。其中,棘白菌素类是治疗IC的首选药物。然而,现有的治疗手段未能改善IC感染患者的预后,长期使用所致的耐药现象频发。目前可用的抗真菌药物数量极其有限。因此,为了解决上述问题,药物联合治疗、辅助免疫治疗、光动力治疗和激光治疗等为治疗IC感染提供了新的视角。该文就免疫力低下人群容易出现的IC感染的流行病学和治疗研究现状进行综述,深入讨论了国内外IC感染在重症住院患者、血液恶性肿瘤患者、实体器官移植患者、新生儿、老年人、人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者中的发病率、死亡率,主要致病念珠菌的菌种分布,以及新的研究方案的治疗潜力和局限性,并提出了未来的研究方向。

With the development of modern medical technology,such as organ transplantation,the extensive application of broad-spectrum antibiotics and immunosuppressants and the prolongation of human life span,the number of people with low immunity is increasing.The morbidity and mortality of invasive fungal infection are increasing in these population.Invasive fungal infection has become the direct cause of death of critical diseases,such as malignant tumor and organ transplantation.Candida is the primary pathogenic fungi of invasive fungal infection.It can infect human subcutaneous tissue,mucous membrane,other tissues and organs of the whole body,and then spread in the blood.The main clinical manifestations of Candida infection are candidemia and deep candidiasis,and the prognosis is often poor.At present,antifungal infection is still the main treatment for invasive Candida(IC)in immunocompromised population,and drug treatment is one of the effective ways.Clinical conventional antifungal drugs include polyenes,azoles and echinocandins.Among them,echinocandins is the first choice for the treatment of IC.However,the existing treatments fail to improve the prognosis of patients with IC infection,and drug resistance caused by long-term use frequently occurr.At present,the number of antifungal drugs available is extremely limited.Therefore,in order to solve the above problems,drug combination therapy,adjuvant immunotherapy,photodynamic therapy and laser therapy provide new perspectives for the treatment of IC.This article reviews the epidemiology and treatment of IC infetcion in the population with low immunity.In this paper,the incidence and mortality of IC infection in patients in intensive care unit,patients with hematological malignancies,solid organ transplant patients,neonates,the elderly,and human immunodeficiency virus(HIV)-infected people at home and abroad,and the distribution of main pathogenic Candida species,as well as the therapeutic potential and limitations of new research were discussed in depth.The future research direction was proposed.