曲霉菌属肺部感染的临床分析
Clinical analysis of pulmonary infections caused by Aspergillus
陈玉玲 1左丽娜 1张文辉 1卞宏 1乔月华1
作者信息
- 1. 徐州医学院附属医院呼吸科,江苏徐州221006
- 折叠
摘要
目的 分析曲霉菌属肺部感染和肺部定植的异同以及影响预后的相关因素,提高鉴别及预防控制肺曲霉菌感染手段.方法 回顾性分析2010年1月-2012年6月痰培养曲霉菌属阳性的住院患者,分为呼吸道曲霉菌属定植和侵袭性肺曲霉病(IPA)两组进行对比研究.结果 181例呼吸道分泌物培养曲霉菌属阳性,其中68例符合临床IPA诊断,发生率37.6％,83例符合呼吸道曲霉菌属定植,定植率为45.8％;患慢性阻塞性肺疾病、血液病和糖尿病均是肺部曲霉菌属感染和定植的高危人群,而肺癌和支气管扩张肺部曲霉菌属定植率更高;长期使用糖皮质激素、化疗、低蛋白血症及粒细胞减少是发生肺曲霉菌病的高危因素(P＜0.05);与定植相比,肺曲霉菌属感染时发热、肺部双侧病变、低氧血症多见,白细胞总数增高显著(P＜0.05);IPA病死率高于呼吸道曲霉菌属定植组(P＜0.05),及时充分的抗曲霉菌属治疗,是影响预后IPA的重要因素.结论 肺曲霉菌属感染和定植发生的主要基础疾病一致,在高危人群中减少高危因素、预防曲霉菌属感染与及时鉴别、诊治肺曲霉菌属感染同样重要.
Abstract
OBJECTIVE To explore the pulmonary colonization of Aspergillus causing pulmonary infections and its impact on the prognosis so as to improve the level of diagnosis,prevention,and control of invasive pulmonary aspergillosis (IPA).METHODS The patients for whom the sputum specimens were cultured positive for Aspergillus from Jan 2010 to Jun 2012 were retrospectively analyzed and divided into the respiratory tract colonization of Aspergillus group and the IPA group,then a comparative study was conducted.RESULTS Of totally 181 patients for whom the respiratory tract secretions were cultured positive for Aspergillus,68 (37.6％) cases complied to the standards of clinical diagnosis of IPA; 83 (45.8 ％) cases conformed to the respiratory tract colonization of Aspergillus.The patients with chronic obstructive pulmonary disease,blood diseases,or diabetes were the population at high risk of Aspergillus infections or pulmonary colonization; the rate of pulmonary colonization of Aspergillus was even higher in the patients with lung cancer or bronchiectasis.The long-term use of glucocorticoids,chemotherapy,hypoproteinemia,and neutropenia were the high risk factors for the IPA(P＜0.05).As compared with the colonization,the cases of fever,bilateral lung lesions,hypoxemia,or elevated WBC count were increased significantly (P＜0.05) ; the mortality of the IPA group was significantly higher than that of the respiratory tract colonization of Aspergillus group (P＜0.05) ; sufficient antifungal therapy would improve the prognosis of IPA.CONCLUSION The major underlying diseases in the patients with Aspergillus infections are as same as the patients with pulmonary colonization; it is equally important to reduce the high risk factors among the high risk population and prevent,identify,and treat the Aspergillus infections.
关键词
肺部感染/痰培养/曲霉菌属/侵袭性肺曲霉菌病Key words
Pulmonary infection/Sputum culture/Aspergillus/Invasive pulmonary aspergillosis引用本文复制引用
出版年
2013
NETL
NSTL
维普
万方数据