摘要
目的探讨痰培养丝状真菌阳性的临床意义。方法回顾性分析140例痰培养丝状真菌阳性患者的临床资料，根据欧洲癌症研究和治疗机构／真菌研究组标准诊断侵袭性肺部真菌感染（IPFI），分析IPFI及非IPFI病例的临床特点。结果140例中22例诊断为IPFI，2例经手术病理证实，1例血培养阳性，余19例为综合考虑宿主因素、肺部感染临床特征和微生物学检查结果（痰真菌培养2—5次阳性）临床诊断。致病菌多为曲霉菌，分离出的菌株数目多数为1株。IPFI组应用广谱抗生素（100％）、激素（13例，59．1％）、免疫抑制剂（7例，31．8％）、有肺部影像学改变（100％）、有基础疾病（21例，95．5％）和低蛋白血症（18例，81．8％）、咯血（10例，45．5％）者所占比例均明显高于非IPFI组（分别为66．9％、34．7％、18．6％、79．7％、72．0％、45．8％和4．2％，均P〈0．05）。IPFI患者经伊曲康唑、二性霉素B和（或）伏立康唑治疗，8例（36．4％）痊愈，14例（63．6％）死亡；非IPFI患者经抗生素、氟康唑、抗结核、糖皮质激素或合用免疫抑制剂、化疗、肺泡灌洗等治疗，96例（81．4％）治愈或好转，22例（18．6％）死亡或自动出院。结论痰培养丝状真菌阳性的临床意义与真菌培养阳性的次数、分离菌株的数目以及分离菌株的种类有关，应结合宿主因素和临床特征两方面来综合分析是否存在IPFI。
Objective To investigate the clinical significance of positive sputum culture for filamentous fungi. Methods The medical data of 140 patients positive for filamentous fungi in sputum culture at Peking Union Medical College Hospital were reviewed retrospectively. Based on the diagnostic criteria by European Organization for Research and Treatment of Cancer/Mycoses Study Group, invasive pulmonary fungal infection （IPFI） was diagnosed. The clinical characteristics of cases with and without IPFI were analyzed respectively. Results Among all 140 cases positive for filamentous fungi in sputum culture, only 22 cases could be diagnosed as IPFI. Two of 22 IPFI cases were confirmed by post-operative pathology, 1 case was confirmed by positive blood culture for filamentous fungi and the remaining 19 cases were diagnosed clinically according to the nature of hosts, characteristics of pulmonary infections and microbiological evidence （positive sputum culture for filamentous fungi, 2 -5 times for each case）. Most of etiological fungi in IPFI patients belonged to Aspergillus. And the identity of isolated fungal strain was mostly one strain for each patient. In IPFI group, patients who had been treated with broad-spectrum antibiotics （ 100% ）, steroids （ 13, 59. 1% ） or immunosuppressant （7, 31.8% ） or who had pulmonary X-ray imaging changes（ 100% ）, primary diseases （21, 95.5% ）, hypoalbuminemia （ 18, 81.8% ） or hemoptysis （ 10, 45.5% ） , were significantly more than those in non-IPFI group （ 66. 9% , 34. 7% , 18. 6% , 79. 7% , 72.0%, 45.8% and 4.2% respectively; P 〈 0.05 for each item） . In IPFI group, itraconazole, amphotericin B and/or voriconazole were administrated, 8 patients （ 36.4% ） were cured and 14 patients （63.6%） passed away. In non-IPFI group, the patients were treated with antibiotics, fluconazole, antituberculosis, steroids or combined with immunosuppressant, chemotherapy or bronchoalveolar lavage; 96 cases （81.4%） were cured or showed improvement, and 22 cas
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第4期245-248,共4页
National Medical Journal of China
关键词
痰
真菌
肺疾病
真菌性
Sputum
Fungi
Lung diseases,fungal
