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目的:探讨复治肺结核并发肺部真菌感染的易患因素、常见菌种及用药特点。方法:整理2012-2013年我院收治的60例复治肺结核并发肺部真菌感染患者的临床资料,对病史、真菌菌种分类、易患因素、诊治及预后进行分析。结果:复治肺结核并发肺部真菌感染的好发人群及易患因素包括高龄、病程长、合并慢性消耗性疾患、有创操作及滥用抗生素和激素等。检出的真菌种类以酵母菌属为主,其中白色念珠菌35例(58.33%),光滑念珠菌15例(25.00%),热带念珠菌6例(10.00%),曲霉菌4例(6.67%)。主要采用2SHRZE/6HRE抗结核化疗方案联合应用氟康唑、酮康唑、伏立康唑、5-氟胞嘧啶、两性霉素B等抗真菌治疗,其中31例治愈(51.67%),27例好转(45.00%),2例无效(3.33%),无死亡病例。结论:临床应避免滥用抗生素和激素,积极治疗基础疾病,加强营养支持,注意调节增强机体免疫功能,从而提高复治肺结核的治愈率。
Objective: To explore the risk factors of pulmonary fungal infection complicated with pulmonary tuberculosis and the characteristics of common bacteria and drug use. Methods: The clinical data of 60 patients with recurrent pulmonary tuberculosis complicated with pulmonary fungal infection admitted from 2012 to 2013 in our hospital were collected. The medical history, fungal species classification, predisposition factors, diagnosis and treatment and prognosis were analyzed. Results: The incidence of pulmonary fungal infection in re-treatment of tuberculosis and risk factors include elderly, long duration, combined with chronic wasting disease, invasive operation and abuse of antibiotics and hormones. Among them, Candida albicans was detected in 35 cases (58.33%), Candida glabrata (25.00%), Candida tropicalis in 6 cases (10.00%), Aspergillus spp. In 4 cases (6.67% ). Anti-fungal treatment with fluconazole, ketoconazole, voriconazole, 5-fluorocytosine, amphotericin B and other antifungal agents were mainly used in the 2SHRZE / 6HRE antituberculous chemotherapy regimen, of which 31 cases were cured (51.67%) and 27 cases were improved %), 2 ineffective (3.33%), no deaths. Conclusions: Abuse of antibiotics and hormones should be avoided clinically, active treatment of underlying diseases, nutritional support should be strengthened and attention should be paid to the regulation and enhancement of immune function so as to improve the cure rate of retreatment tuberculosis.