肺部真菌感染152例病原谱再评价

目的了解肺部真菌感染的病原谱和预后。方法根据欧洲癌症研究和治疗侵袭性真菌感染协作组（EORTC）、美国变态反应和感染性疾病协会真菌病研究组（MSG）2002年制定的定义以及血液病／恶性肿瘤患者侵袭性真菌感染的诊断标准，将北京协和医院2002年1月至2006年6月诊断的152例肺部真菌感染患者按照统一的定义进行重新分组：确诊组38例，临床诊断组24例，拟诊组35例，定植组55例，重新分析病原谱。结果38例确诊肺部真菌感染的患者中，肺曲霉菌感染占首位（15／38），其次为肺隐球菌感染（13／38），第三为毛霉菌和其他类型丝状真菌，而真正念珠菌肺炎少见，只有2例。临床诊断组曲霉菌和曲霉菌＋念珠菌占第1位，而拟诊组以及定植组以单纯念珠菌占首位。临床诊断组病死率为58．3％，高于拟诊组（25．7％）和定植组（16．4％）。拟诊组和定植组“念珠菌肺炎”分别为28例和50例，对这78例“念珠菌肺炎”患者的预后危险因素进行分析后发现，只有急性生理和慢性病评分（APACHEⅡ）与患者的预后有关，而是否抗真菌治疗及使用何种抗真菌药物与预后无关。结论肺部真菌感染以曲霉菌占第1位，其次为隐球菌和毛霉菌，念珠菌肺炎少见。痰标本念珠菌属培养阳性作为“念珠菌肺炎”的诊断标准值得商榷。

A study of 152 cases of pulmonary fungal infection: reevaluation of the microbiological spectra

OBJECTIVE: To investigate the microbiological spectra and clinical outcome of patients with pulmonary fungal infections. METHODS: All the cases of clinically diagnosed pulmonary fungal infection from January 2002 to June 2006 were reevaluated according to the definitions of European Organization for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), and the etiology of the patients were analyzed. RESULTS: Pulmonary fungal disease was classified as proven (n = 38), probable (n = 24), possible (n = 35) and colonization (n = 55). In the proven group, the most frequently encountered fungi were Aspergillus species (15/38), followed by Cryptococcus species (13/38), Candida species were rare (2/38). In the probable group, Aspergillus species and Aspergillus species + Candida species were among the most common pathogens; while in the possible group and the colonization group, Candida species were most frequently encountered. The mortality of patients with probable pulmonary fungal infection (58.3%) was higher than that of patients in the possible group (25.7%) or the colonization group (16.4%) (P = 0.001). Univariate analysis showed that only APACHE II score was associated with outcome of patients with "pulmonary Candida infections", and antifungal therapy did not improve the outcome of such patients. CONCLUSION: The most frequently encountered fungi in patients with pulmonary fungal infections were Aspergillus species, followed by Cryptococcus species. Primary Candida pulmonary infections were rare.