105例病理确诊深部真菌感染临床分析

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1、•论著•105例侵袭性真菌感染临床分析伍远辉▽黄小甜从陈甘海"姜椿法▽卢毅容'王华'I南方供科大学珠江供院東症供学科，广东广州51028厶2广东省东莞市厚街供院急诊科；3广东省兴宇市人民医院重症医学科)【摘要】目的分析105例病理确诊的侵袭性真菌感染(invasivefungalinfection,IFI)病例资料，为临床诊断和治疗提供借鉴。方法采用回顾性病例分析方法，收集我院2011年1月至2014年12月

2、'可105例经组织病理确诊的IFI病例资料，分析真菌病原学分布和临床特点。结果92.4%的病例为院外获得性感染，52.4%的病例无IFI危险因素。手术取材、CT引导下

3、穿刺和内镜下活检是主要的确诊方法。IFI病原菌以曲每(54.3%)为主，其次为毛霉(8.6%)、隐球菌(4.8%)和假丝酵母菌(3.8%)。33.3%的IF1病例伴有肺部侵犯，胸部影像学和临床表现对诊断的特异性不强。73.3%的病例手术清除病灶，6例手术联合抗真菌治疗，26.7%的病例仅针对性抗真菌治疗。随访7例死亡或治疗无效。结论积极有创检查和早期确诊、手术和针对性抗真菌治疗减少IFI患者的病死率。【关键词】侵袭性真菌感染；真菌；病原学分布；回顾性病例分析ClinicalAnalysisof105CaseswithInvasiveFungalInfection.CHENY

4、anbo,WUYuan-hui,HUANGXiaotian,LUYirong/WANGHua.CriticalCareDepartment,ZhujiangHospital,SouthernMedicalUniversity.GuangZhou510282,China.Correspondingauthor:WANGHua,E-mail:wang/iua7399@sina.com[Abstract]ObjectiveToinvestigatetheclinicalcharacteristicsofinvasivefungalinfection(IFI).MethodClin

5、icaldataof105caseswithpathologicallyconfirmedIFIatatertiaryteachinghospitalfromJanuary2011toDecember2014wereanalyzedretrospectively.ResultsCommunity-acquiredIFIaccountedfor92.4%ofallcasesandatotalof52.4%patientswithnoevidentriskfactors.Surgicalinterventionsandneedlebiopsyguidedbycomputeriz

6、edtomographyorunderendoscopyweretheprincipalmethodstoobtainspecimensanddefinitediagnoses.Themostcommonlyseenfungiwereaspergillus(54.3%),mucormycosis(8.6%),cryptococcus(4.8%)andCandidaspecies(3.8%),respectively.Atotalof33.3%patientspresentedlunginvolvement,基金项目：广东省省级科技计划项H(2014A020212670)通信

7、作者：王华，Email：vvanghua7399@sina.comthoughthechestimagingfindingsandclinicalmanifestationswerenon-specifictoconfirmsufficientlyadiagnosisofpulmonaryIFI.73.3%ofpatientsreceivedsurgicalexcisionsoffocusofinfection,6caseswithsurgicalinterventionsandantifungaltherapies,and26.7%withtargetedantifung

8、altreatmentonly.Sevenpatientsdiedorwithnoeffectafterfollow-upuntilhospitaldischarge・ConclusionAggressivebiopsyandearlydiagnosiswithsurgicalinterventionsanddefinitiveantifungaltreatmentwerebeofparamountimportanceforafavorableoutcome・[Keywords]invasivefungalinfe