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中华临床感染病杂志
中华临床感染病杂志

李兰娟

双月刊

1674-2397

zhgrb@126.com

0571-87236590

310003

浙江省杭州市庆春路79号浙医一院内

中华临床感染病杂志/Journal Chinese Journal of Clinical Infectious DiseasesCSCDCSTPCD北大核心
查看更多>>2008年4月，中国科学技术协会主管，中华医学会主办。本刊为“中国科技论文统计源期刊”，重点报道感染病领域的最新科研成果和临床诊治经验，以感染病专业临床、预防、科研和教学工作者为读者对象。杂志为双月刊，设有标准与指南、专家论坛、论著、诊疗分析、护理园地、病例报告和综述等栏目。投稿和订阅请直接联系编辑部。
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    乙型病毒性肝炎全人群管理专家共识（2023）

    中国医师协会感染科医师分会彭芳李兰娟金建华...
    1-13页
    查看更多>>摘要：目前我国乙型肝炎病毒（Hepatitis B virus，HBV）感染者诊断率和治疗率与世界卫生组织提出的"2030年消除病毒性肝炎作为公共卫生危害"目标仍有较大差距。为实现乙型病毒性肝炎全人群治疗，中国医师协会感染科医师分会、国家感染性疾病临床医学研究中心邀请国内感染病和肝炎疾病领域相关专家，在充分复习国内外相关指南与文献的基础上，共同撰写《乙型病毒性肝炎全人群管理专家共识（2023）》，以进一步扩大乙型肝炎社区筛查，规范抗病毒治疗适应群体，细化各类特殊人群乙型肝炎患者治疗，针对《慢性乙型肝炎防治指南（2022）》未覆盖人群进行临床管理，从而实现乙型病毒性肝炎的扩大筛查、应治尽治、全程管理、降本增效的目的。 There is still a substantial gap between the current diagnosis and treatment rates of hepatitis B virus (HBV) infection in China and the the goal of eliminating viral hepatitis as a major public health threat by 2030 set by World Health Organization. In order to achieve the management of viral hepatitis type B infection in a whole population approach, the Infectious Disease Physicians Branch of Chinese Medical Doctor Association and National Clinical Research Center for Infectious Diseases invited experts in the field of infectious diseases and hepatitis diseases to jointly develop the Expert consensus on whole-population management of hepatitis B virus infection (2023) based on reviewing relevant guidelines and literature at home and abroad. The expert consensus further simplifies the indications for antiviral treatment, refines the treatment of special types of patients, and guides the clinical management of populations not covered by Guidelines for the prevention and treatment of chronic hepatitis B (version 2022) to achieve the expanded screening and universal treatment of hepatitis B virus infection.

    乙型肝炎病毒抗病毒治疗全人群共识

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    人工肝血液净化系统治疗细胞因子风暴综合征专家共识

    中华医学会感染病学分会肝衰竭与人工肝学组传染病重症诊治全国重点实验室国家传染病医学中心李兰娟...
    14-22页
    查看更多>>摘要：细胞因子风暴综合征（cytokine storm syndrome，CSS）是一种由感染、肿瘤和自身免疫性疾病等病因引起的免疫反应失控的临床综合征。患者主要表现为血浆中细胞因子水平明显升高，并出现发热、全身多个系统或脏器发生炎症反应及功能损害，甚至衰竭而死亡。人工肝血液净化系统治疗能清除炎症因子，减轻炎症反应对机体的损伤，其在重症H7N9、重型/危重型新型冠状病毒感染患者临床救治中具有重要应用价值。专家组在《人工肝血液净化系统应用于重型、危重型新型冠状病毒肺炎治疗的专家共识》基础上，结合现有临床应用经验及国内外研究进展，针对人工肝血液净化系统治疗CSS患者的基本原理、治疗适应证、相对禁忌证、治疗模式选择、监测指标及疗效评价等进行总结，制订了本专家共识，供临床医护人员参考。 Cytokine storm syndrome（CSS）is a clinical syndrome characterized by uncontrolled immune reaction caused by infection，tumor or autoimmune diseases. It is mainly manifested by significantly elevated plasma cytokines levels，leading to fever，inflammation and functional damage in multiple systems or organs，and even death due to organ failure. The artificial liver blood purification system can effectively remove inflammatory factors and alleviate the damage of inflammation in CSS. It has important clinical application value in the treatment of severe H7N9 and severe/critical COVID-19 patients. Based on the Expert consensus on the application of artificial liver blood purification system in the treatment of severe and critical COVID-19，combined with clinical experiences，and domestic and foreign research progress，this expert consensus summarizes the basic principles，indications for treatment，relative contraindications，selection of treatment modes，monitoring indicators，and evaluation of efficacy of artificial liver blood purification system in the treatment of CSS patients，to provide reference for clinical application.

    人工肝血液净化细胞因子风暴共识

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    HIV感染抗反转录病毒治疗后肥胖患者体重管理专家共识（2024版）

    中华医学会热带病与寄生虫病分会艾滋病学组浙江省数理医学学会感染性疾病专业委员会李亭亭刘寿荣...
    23-33页
    查看更多>>摘要：肥胖是心血管疾病、糖尿病及其他代谢性疾病的重要危险因素。目前全球一般人群肥胖患病率逐年上升，人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者也面临着肥胖的问题，特别是新型抗反转录病毒治疗（antiretroviral therapy，ART）相关的体重增加已成为日益关注的健康问题。科学合理的体重管理是肥胖及预防相关慢性疾病的基础治疗手段。为了规范HIV感染者体重管理，中华医学会热带病与寄生虫病分会艾滋病学组、浙江省数理医学学会感染性疾病专业委员会和浙江省性病艾滋病防治协会艾滋病诊疗质控管理专业委员会邀请有关专家，结合国内外指南共识及最新研究进展制订HIV感染者体重管理专家共识，针对体重管理设立标准化的流程，使超重或肥胖者的体重管理科学、规范和易于实施。 Obesity is a risk factor for cardiovascular disease, diabetes and other metabolic diseases, with a increased prevalence rate in the general population globally. People living with HIV are also facing obesity problems, in particular, weight gain associated with new antiretroviral therapy (ART) has become a growing health concern. Rational and standardized weight management is important for obese population in the prevention and treatment of related chronic diseases. The AIDS Committee of Chinese Society of Tropical Disease and Parasitology the Infection Disease Committee of Zhejiang Society for Mathematical Medicine and the Committee of AIDS Diagnosis and Treatment Quality Control Management of Zhejiang Provincial STD/AIDS Prevention Association invited experts in relevant fields to develop this expert consensus in reference of the related domestic and foreign guidelines and the latest research progress, to provide standardized procedures of weight management for overweight or obese people living with HIV after ART.

    人类免疫缺陷病毒抗反转录病毒治疗肥胖体重管理

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    2023年重大感染性疾病流行动态与对策

    王雪婷陈涛熊璐颖葛淇...
    33-41页
    查看更多>>摘要：回顾2023年，世界卫生组织宣布新型冠状病毒流行结束，但年末我国呼吸道感染呈小的流行高峰，提示传染病依旧需要高度关注。过去一年，全球在应对传染病的科学步伐不断前进，取得了一些突破，本文就2023年度感染性疾病领域发生的大事记及感染性疾病诊断和防治方面取得的重大研究进展进行简介，以飨读者。 In 2023，World Health Organization（WHO）announced that the pandemic of COVID-19 is over；while there was an epidemic of multi-pathogenic infections in the respiratory tract by the end of the year in China，indicating that high attention still need to be paid to infectious diseases. In the past one year，some breakthroughs for infectious diseases have been achieved.This article reviews the major events and research progress in the diagnosis，prevention and treatment of infectious diseases in 2023.

    感染性疾病新型冠状病毒感染微生物组疗法新型抗菌药物新型疫苗肿瘤细胞内微生物组

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    2022年全国血流感染细菌耐药监测报告：革兰阴性菌

    刘志盈陈云波嵇金如应超群...
    42-57页
    查看更多>>摘要：目的 监测全国血流感染革兰阴性菌病原谱分布及其耐药趋势，为临床血流感染治疗及细菌耐药防控提供参考。 方法 收集全国血流感染细菌耐药监测联盟成员单位2022年1至12月所有分离自血培养阳性的革兰阴性菌，按照美国临床和实验室标准化研究所（CLSI）推荐的稀释法进行抗菌药物敏感性测定。采用WHONET 5.6和SPSS 25.0软件进行统计分析。 结果 共收集51家医院革兰阴性菌9 035株，其中肠杆菌目细菌7 895株（87.4%），非发酵菌1 140株（12.6%）；排在前5位的病原菌为大肠埃希菌4 510株（49.9%）、肺炎克雷伯菌2 340株（25.9%）、铜绿假单胞菌534株（5.9%）、鲍曼不动杆菌复合体405株（4.5%）及阴沟肠杆菌327株（3.6%）。产超广谱β-内酰胺酶（EBSLs）大肠埃希菌、EBSLs（+）肺炎克雷伯菌和EBSLs（+）变形杆菌属检出率分别为47.1%（2 095/4 452）、21.0%（427/2 033）和41.1%（58/141）；耐碳青霉烯类大肠埃希菌（CREC）、耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率分别为1.3%（58/4 510）和13.1%（307/2 340）；CREC和CRKP对头孢他啶/阿维巴坦的耐药率分别为62.1%（36/58）和9.8%（30/307）。耐碳青霉烯类鲍曼不动杆菌（CRAB）复合体的检出率为59.5%（241/405），鲍曼不动杆菌复合体对替加环素和多黏菌素B的耐药率均<5%。耐碳青霉烯类铜绿假单胞菌（CRPA）的检出率为18.4%（98/534）。血流感染革兰阴性菌构成比及主要耐药菌在不同地区的检出率存在差异，其中CRKP和CRPA检出率差异有统计学意义（χ2=20.489和20.252，P<0.001）。省级医院的CREC、CRKP、CRPA、CRAB、ESBLs（+）大肠埃希菌及ESBLs（+）肺炎克雷伯菌检出率均高于地市级医院（χ2=11.953、81.183、10.404、5.915、12.415和6.459，P<0.01或<0.05）；人均GDP≥92 059元地区的CRPA检出率高于人均GDP<92 059元地区（χ2=6.240，P=0.012）。 结论 我国血流感染革兰阴性菌分离率呈上升趋势，其中大肠埃希菌占首位，肺炎克雷伯菌分离率上升明显；ESBLs（+）大肠埃希菌和ESBLs（+）肺炎克雷伯菌的流行率呈下降趋势，CREC保持低水平流行，CRKP流行率呈下降趋势，CRAB复合体仍保持高水平流行率；我国不同地域的血流感染革兰阴性菌构成比和耐药株略有不同，主要耐药菌在省级医院较为突出。 Objective To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022. Methods The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data. Results During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（n=4 510，49.9%），Klebsiella pneumoniae（n=2 340，25.9%），Pseudomonas aeruginosa（n=534，5.9%），Acinetobacter baumannii complex（n=405，4.5%）and Enterobacter cloacae（n=327，3.6%）. The ESBLs-producing rates in Escherichia coli，Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（χ2=20.489 and 20.252，P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producingEscherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（χ2=11.953，81.183，10.404，5.915，12.415 and 6.459，P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（χ2=6.240，P=0.012）. Conclusions The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

    革兰氏阴性菌抗药性血流感染全国范围耐药监测

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    核酸基质辅助激光解吸电离飞行时间质谱技术在痰涂片阴性非结核分枝杆菌肺病中的诊断价值

    高绪胜丁彩红王庆解丹...
    58-63页
    查看更多>>摘要：目的 评估核酸基质辅助激光解吸电离飞行时间质谱（matrix-assisted laser desorption ionization-time of flight mass spectrometry，MALDI-TOF MS）技术在痰抗酸染色涂片阴性非结核分枝杆菌（nontuberculous Mycobacteria，NTM）肺病患者中的诊断价值。 方法 回顾性收集2022年7月至2023年11月在山东大学附属公共卫生临床中心住院的痰抗酸染色涂片阴性疑似NTM肺病123例患者临床资料。对支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）标本进行MALDI-TOF MS技术检测和MGIT 960培养。评估MALDI-TOF MS技术在痰抗酸染色涂片阴性NTM肺病中的诊断效能。采用SPSS 26.0软件对数据进行统计分析。采用MedCalc统计软件绘制受试者工作特征（receiver operating characteristic，ROC）曲线，并计算曲线下面积（area under curve，AUC）。 结果 123例痰抗酸染色涂片阴性疑似NTM肺病患者中，最终确诊NTM肺病 66例。MALDI-TOF MS检测NTM菌种和耐药的时间为8~24 h，共分离72株NTM，居首位的是鸟分枝杆菌复合群34株（47.22%），其次是脓肿分枝杆菌复合群13株（18.06%），有6例患者检测到大环内酯类耐药，未检测到氨基糖苷类药物耐药。BALF MGIT 960培养和鉴定时间为9~45 d，NTM分型和药敏检测时间为7~15 d，共分离28株NTM，有1例患者检测到大环内酯类耐药。以确诊诊断为金标准，MALDI-TOF MS技术检测痰抗酸染色涂片阴性NTM肺病的敏感度、阴性预测值和符合率均高于MGIT 960培养，差异均有统计学意义（84.85%比42.42%，81.13%比56.32%，80.49%比62.60%，χ2=25.667、8.998和9.664，P<0.05或<0.01）。MALDI-TOF MS技术的ROC AUC为0.801，高于MGIT 960培养的AUC（0.642）。MALDI-TOF MS技术的诊断效能高于MGIT 960培养（Z=3.300，P=0.001）。 结论 相比MGIT 960培养，MALDI-TOF MS技术在诊断痰抗酸染色涂片阴性NTM肺病患者的诊断效能更高，同时能鉴定NTM菌种及耐药情况，且时间更短。 Objective To investigate the diagnostic value of nucleic acid matrix-assisted laser desorption ionization-time of flight mass spectrometry（MALDI-TOF MS）in sputum smear-negative patients with nontuberculous Mycobacterial（NTM）pulmonary disease. Methods Clinical data of 123 patients suspected of NTM pulmonary disease admitted in Public Health Clinical Center Affiliated to Shandong University between July 2022 and November 2023 were retrospectively analyzed. Bronchoalveolar lavage fluid（BALF）specimens were collected for MALDI-TOF MS assay and MGIT 960 culture. The diagnostic efficacy of MALDI-TOF MS for NTM pulmonary disease in patients with negative sputum smears for acid-fast bacilli was evaluated with receiver operating characteristic（ROC）curve. Statistical analysis was performed using SPSS 26.0 software and MedCalc statistical software. Results Diagnosis of NTM pulmonary disease was finally confirmed in 66 out of the 123 suspected patients. It took 8 to 24 h for MALDI-TOF MS to identify NTM species and resistance. By MALDI-TOF MS，72 NTM strains were identified，with the Mycobacterium avium complex being the most prevalent（34 strains，47.22%），followed by the Mycobacterium abscessus complex（13 strains，18.06%）；resistance to macrolides was detected in 6 cases，while no resistance to aminoglycosides was found. It took 9 to 45 days for BALF MGIT 960 culture to identify NTM，and took 7 to 15 days for NTM typing and drug sensitivity testing. By BALF MGIT 960 culture，28 NTM strains were identified；and 1 case was found to be resistant to macrolides. Using confirmed diagnosis as the gold standard，MALDI-TOF MS demonstrated higher sensitivity，negative predictive value，and agreement rate compared to MGIT 960 culture（84.85% vs. 42.42%，81.13% vs. 56.32%，80.49% vs. 62.60%，χ2=25.667，8.998，9.664，P<0.05 or <0.01）. The area under ROC curve（AUC）for MALDI-TOF MS was significantly higher than that of MGIT 960 culture（0.801vs. 0.642，Z=3.300，P=0.001）. Conclusion Compared to MGIT 960 culture，MALDI-TOF MS exhibits superior diagnostic efficiency in detecting NTM pulmonary disease in patients with acid-fast bacilli smear-negative sputum，with advantage of rapidly identifying NTM species and resistance.

    基质辅助激光解吸电离飞行时间质谱非结核分枝杆菌肺病支气管肺泡灌洗液诊断

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    孤立肾尿路上皮癌误诊为肾脓肿1例

    肖袁丽马路园赵彩彦彭芳...
    64-67页
    查看更多>>摘要：肾实质浸润性尿路上皮癌是起源于肾盏上皮细胞，向肾实质内浸润性生长的恶性肿瘤，其临床表现缺乏特异性，影像学表现与肾盂肾炎、肾脓肿及肾结核等极为相似，因此临床容易误诊。本例患者首诊症状为反复发热，炎症指标明显升高，腹部影像学多次提示残余肾脓肿，经验性抗感染治疗无效，最终筛查尿核基质蛋白弱阳性，残余肾穿刺活检确诊为肾实质浸润性尿路上皮癌。感染性疾病的诊疗需要明确感染病灶及病原体，对于非典型感染病灶需及时获取组织病理辅助诊断，避免误诊、漏诊。

    肾肿瘤肾实质浸润性尿路上皮癌病理

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    人型支原体和解脲脲原体泌尿生殖系统外感染研究进展

    赵凝秋倪玲美杨青瞿婷婷...
    68-74页
    查看更多>>摘要：一般认为人型支原体和解脲脲原体主要存在于泌尿生殖道，很少进入组织和血液。近年来，人型支原体和解脲脲原体引起的泌尿生殖系统外感染病例逐年增加，且呈现多重耐药趋势，而检测和诊断有难度，导致治疗延迟。本文就人型支原体和解脲脲原体泌尿生殖系统外感染的病原学特点、实验室诊断、感染类型及治疗方案等研究进展进行阐述，以期为病因诊断和治疗提供意见。 It is generally accepted that Mycoplasma hominis and Ureaplasma urealyticum are primarily found in the genitourinary tract and rarely enter the tissues and bloodstream. In recent years，cases of extra-genitourinary system infections caused by Mycoplasma hominis and Ureaplasma urealyticum have been increasing with a trend of multi-drug resistance，while detection and diagnosis are difficult，leading to treatment delay clinically. This article reviews the latest research progress on the pathogenic characteristics，laboratory diagnosis，infection types，and treatment options of extra-genitourinary system infections caused by Mycoplasma hominis and Ureaplasma urealyticum，in order to provide reference for etiological diagnosis and treatment of the infection.

    人型支原体解脲脲原体泌尿生殖系统外感染多重耐药

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    白细胞介素17A在脓毒症相关脏器损伤中的研究进展

    顾颢迪林辉单跃李亭亭...
    75-80页
    查看更多>>摘要：脓毒症是机体对感染的反应失调，引起器官功能损害而危及生命的一种病理状态，是世界范围内死亡的主要原因之一。然而针对脓毒症仍缺乏有效的防治手段。白细胞介素17A（interleukin17A，IL-17A）是一种主要由活化T淋巴细胞产生的致炎细胞因子，参与宿主防御、组织修复、炎症疾病的发病机制和癌症的进展。本文综述IL-17A在脓毒症相关器官损伤中的研究进展，以期为临床治疗脓毒症相关脏器损伤提供新的治疗策略。 Sepsis is a pathological condition in which the body’s response to infection is dysfunctional and may lead to life-threatening organ failures as one of the leading causes of death worldwide. However，there is still a lack of effective prevention and treatment for sepsis. IL-17A is an inflammatory cytokine produced primarily by activated T cells and is involved in host defense，tissue repair，the pathogenesis of inflammatory diseases，and the progression of cancer. This article reviews the recent research progress on the roles of IL-17A in sepsis-related organ damage，and its potentials as a novel therapeutic target for the clinical treatment of sepsis.

    白细胞介素17A脓毒症脏器损伤信号通路

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