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目的探讨实体肿瘤合并侵袭性真菌感染患者的特点、临床表现、诊治及预后。方法对1995年1月至2005年8月间在北京协和医院住院治疗的所有实体肿瘤合并侵袭性真菌感染的患者进行回顾性分析。结果10年间共有37例实体肿瘤患者合并侵袭性真菌感染。感染部位:肺部34例,胆道1例,泌尿系4例,真菌血症3例。37例患者中共分离培养出48株真菌,念珠菌属37株,曲菌属6株,青霉菌属2株,顶孢霉属1株,未分类真菌2株。合并真菌感染的患者89%肿瘤分期为Ⅳ期,92%的患者曾使用多种广谱抗生素,出现中性粒细胞减少的患者比例为19%。不同部位真菌感染临床表现无特异性。37例中23例死亡,9例有效,1例手术后缓解,4例无法判断疗效。结论实体肿瘤患者侵袭性真菌感染发病率逐年增加;感染的菌种以念珠菌为主,约占80%,白色与非白色念珠菌几乎各占一半,曲菌居第2位,约占12·5%;实体肿瘤合并真菌感染的病死率高达62%。
Objective To investigate the characteristics, clinical manifestations, diagnosis, treatment and prognosis of patients with solid tumor complicated with invasive fungal infection. Methods A retrospective analysis was performed on all solid tumor patients with invasive fungal infection hospitalized at Peking Union Medical College Hospital from January 1995 to August 2005. Results A total of 37 solid tumors in 10 years had invasive fungal infections. Infected parts: 34 cases of lung, biliary in 1 case, urinary tract in 4 cases, 3 cases of fungal bacteremia. Among the 37 patients, 48 strains of fungi were isolated, 37 Candida species, 6 strains of Aspergillus, 2 strains of Penicillium, 1 strain of Acremonium and 2 strains of unclassified fungi. Eighty-nine percent of patients with fungal infections had stage IV tumors, 92% had multiple broad-spectrum antibiotics, and 19% had neutropenia. Fungal infections in different parts of the clinical manifestations of non-specific. Of the 37 cases, 23 died, 9 were effective, 1 was relieved after surgery, and 4 were unable to judge the efficacy. Conclusion The incidence of invasive fungal infection in patients with solid tumors is increasing year by year. The majority of infected bacteria are Candida albicans, accounting for about 80%. Almost half of white and non-white Candida species are present, and the second is aspergillus, accounting for 12% 5%; solid tumor combined with fungal infection mortality as high as 62%.