2008-2012年肺部真菌感染临床分析

发布时间：2018-11-04 13:12

【摘要】：目的总结肺部真菌感染的临床诊治经验,从而提高临床对肺部真菌感染诊断的认识,以提高诊断率。方法回顾性分析2008年1月-2012年9月医院诊断为肺部真菌感染的132例患者临床特点,分为拟诊组36例、临床诊断组68例、确诊病例组28例,并比较临床实验室检查在诊断肺部真菌感染的价值。结果 132例肺部真菌感染患者中拟诊和确诊、临床诊断患者分别占27.3%、21.2%和51.5%,其中108例患有基础疾病,主要是肺部疾病,其次有肿瘤性疾病和神经系统疾病等;89.4%病例进行了血清1-3-β-D葡聚糖抗原检测(G试验)检查,确诊与临床诊断病例试验阳性率分别是100.0%和85.0%;痰涂片检查与血培养检查阳性率比较低;痰培养阳性率比较高;影像学主要表现为双肺片状影、结节影或高密度影或磨玻璃样改变,24.2%表现为空洞团块影;40例进行病理学检查,28例为阳性,阳性率70.0%;89.7%接受了抗真菌治疗,所用药物以唑类为主,其次是两性霉素B,132例肺部真菌感染患者死亡24例,病死率18.2%。结论肺部真菌感染临床表现缺乏特异性、病死率高,需要行侵入性手段协助诊断以早期诊断和治疗,G试验是灵敏度高、特异性好的方法。
[Abstract]:Objective to summarize the experience of diagnosis and treatment of pulmonary fungal infection and improve the clinical diagnosis of pulmonary fungal infection. Methods the clinical features of 132 patients diagnosed as pulmonary fungal infection from January 2008 to September 2012 were retrospectively analyzed. The patients were divided into three groups: 36 patients, 68 patients in clinical diagnosis group and 28 patients in confirmed case group. The value of clinical laboratory examination in the diagnosis of pulmonary fungal infection was compared. Results among 132 patients with pulmonary fungal infection, the clinical diagnosis accounted for 27.321.2% and 51.5% respectively. Among them, 108 cases suffered from basic diseases, mainly pulmonary diseases. The second is tumor disease and nervous system disease. Serum 1-3- 尾 -D-glucan antigen test (G test) was performed in 89.4% of the cases. The positive rates of confirmed and clinically diagnosed cases were 100.0% and 85.0%, respectively. The positive rate of sputum smear examination was lower than that of blood culture, and the positive rate of sputum culture was higher. Pathological examination was performed in 40 cases, 28 cases were positive, the positive rate was 70.0%. 89. 7% received antifungal therapy. The main drugs were azolium, followed by amphotericin BX 132 patients died of pulmonary fungal infection in 24 cases, the mortality was 18. 2%. Conclusion the clinical manifestation of pulmonary fungal infection is lack of specificity and the mortality is high. It is necessary to use invasive methods to assist in the early diagnosis and treatment. G test is a highly sensitive and specific method.
【作者单位】：南方医科大学珠江医院检验医学部;南方医科大学检验系;
【基金】：广东省科技攻关基金资助项目(2010B031600239)
【分类号】：R519

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