金黄色葡萄球菌肺炎合并侵袭性肺曲霉菌病1例

患者男,24岁.因发热近1个月,胸闷、气急、咳嗽2 d于2005年11月17日入院.患者于2005年10月20日开始无诱因出现畏寒、发热,体温最高达41 ℃,无明显规律,自服感冒药物治疗无效.11月4日出现持续高热,在当地医院予以抗感染(青霉素160万单位静脉滴注)治疗6 d未缓解.10日摄X线胸片示右下肺片状阴影,给予静滴先锋V治疗.12日血培养为金黄色葡萄球菌生长,对先锋V、万古霉素敏感,继续先锋V抗感染治疗效果差.     

两性霉素B脂质体与伏立康唑治疗侵袭性肺曲霉菌病临床对比观察

目的对比观察伏立康唑与两性霉素B脂质体治疗侵袭性肺曲霉菌病的效果和不良反应。方法研究对象为62例疑似或确诊侵袭性肺曲霉菌病患者,根据治疗药物不同分为伏立康唑组28例、两性霉素B脂质体组34例。伏立康唑组首日给予负荷剂量伏立康唑,6 mg/kg、2次/d;此后给予维持剂量,即3 mg/kg、2次/d。两性霉素B脂质体组给予两性霉素B脂质体治疗,起始剂量及维持剂量均为0.3 mg/kg、1次/d。有明确病原学证据时伏立康唑组剂量增至4 mg/kg、2次/d,两性霉素B组剂量增至0.6 mg/kg、1次/d。比较两组治疗效果及不良反应。结果伏立康唑组及两性霉素B组治愈率分别为28.6%、44.1%,P<0.05;总有效率分别为42.8%、58.8%,P<0.05。伏立康唑组用药期间未出现肾功能损害,两性霉素B脂质体组出现肾功能损害3例,P<0.05。结论两性霉素B脂质体治疗侵袭性肺曲霉菌病的有效率及治愈率均高于伏立康唑,但肾功能损害发生率高于伏立康唑。     

侵袭性肺曲霉菌病的临床诊治进展

侵袭性肺曲霉菌病是深部真菌感染性疾病，近年来发病率大大增加，死亡率极高，传统的诊断方法非常困难，治疗效果不佳。近年来，该病在诊断治疗上有很大的进展，本文就此进行综述。     

支气管哮喘合并侵袭性肺曲霉菌病5例并文献复习

目的 提高对支气管哮喘患者合并侵袭性肺曲霉菌病的诊断及治疗.方法 分析2010年1月至2011年5月在我院呼吸科住院的5例支气管哮喘并侵袭性肺曲霉菌病患者的病例资料,同时结合相关文献进行复习.结果 5例患者确诊2例,临床诊断3例.痰培养4例查见曲霉菌,2例支气管镜检查病理形态学及特殊染色结果符合曲霉菌感染.影像学表现呈多样性.5例患者均接受伏立康唑治疗,其中2例死亡.结论 支气管哮喘患者合并侵袭性肺曲霉菌病临床表现缺乏特异性.早期诊断和尽早抗曲霉菌治疗可降低死亡率.     

侵袭性肺曲霉菌病25例的CT诊断

侵袭性肺曲霉菌病是一种严重的肺机遇性感染性病变,其发病率及病死率有逐渐升高之势[1 3 ] ,而且多并发于免疫抑制性患者,如白细胞减少症、大量使用糖皮质激素或免疫抑制剂、器官移植术后、淋巴网状内皮系统和血液系统恶性肿瘤等。因此,侵袭性肺曲霉菌病的早期诊断对临床治疗尤其重要。侵袭性肺曲霉菌病的早期诊断非常困难,由于该病的早期临床表现及X线平片无特异性,痰培养的阳性率低于10 % [4] ,CT扫描是诊断肺曲霉菌病的重要手段之一,尤其是随着薄层、高分辨率CT扫描的广泛应用,侵袭性肺曲霉菌病的CT表现更趋特征性[5] ;我们通过回顾分…     

52例侵袭性肺曲霉菌病临床分析

目的分析侵袭性肺曲霉菌病(IPA)的临床特征。方法对52例IPA患者的基础疾病、宿主因素、临床特征、治疗及转归进行回顾性分析。结果原发性IPA共8例,均获治愈;44例继发性IPA患者,治愈35例,死亡9例。恶性肿瘤放化疗、器官移植、慢性阻塞性肺病急性加重者中,继发性IPA的发病率较高,其临床表现主要有发热、咳嗽、咳痰、喘息、呼吸困难、咯血。IPA患者的肺CT改变呈多样性,并呈动态演变。结论原发性IPA一般预后良好,继发性IPA好发于免疫缺陷的患者,临床表现缺乏特异性,肺CT具备一定的特征,结合宿主因素,为早期治疗提供诊断依据,从而改善预后。     

慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的研究进展

近年来,慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)发病率不断增高,该类患者预后差、病死率高,早期诊断、及时治疗是改善其预后的重要措施。本文结合相关文献对COPD合并IPA的发病机制、临床特征、实验室检查、诊断及治疗等进行综述,为临床医生早期诊断和及时治疗该病提供参考。     

慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素。方法采用病例对照研究方法,选取2015-05～2018-05该院呼吸内科住院的COPD合并IPA的住院患者24例为病例组,以年龄为匹配因素(±2岁),按1∶2的比例选取同期住院的COPD患者48例为对照组,采用条件Logistic回归分析对COPD合并IPA的危险因素进行分析。结果单因素分析结果显示COPD频繁急性加重、糖尿病、慢性肾功能不全、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的危险因素(P0.10);采用条件Logistic分析,糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素(OR=7.384,6.681,32.354,P0.05)。结论糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素。     

侵袭性肺曲霉菌病一例及文献复习

侵袭性肺部真菌感染(IPFI)是指不包括真菌寄生和过敏所致的支气管肺部真菌感染,分为原发性和继发性两种类型。曲霉菌属真菌,是常见的致病真菌,随着广谱抗生素、糖皮质激素、抗肿瘤药物及免疫抑制剂的广泛应用,侵袭性肺曲霉菌病(IPA)发病率逐渐增高,但部分患者无明显诱因,给临床诊断及治疗带来困难。本文总结了1例IPA患者从临床经验性治疗到临床诊断性治疗的过程,并复习相关文献,对IPA的诊治有一定参考价值。     

急性白血病合并侵袭性肺曲霉菌病1例报道并文献复习

目的 讨论侵袭性曲霉菌病在免疫抑制患者中的临床特征及诊断治疗方法。方法 报道1例急性白血病患者合并侵袭性曲霉菌病的临床病例,同时进行相关文献复习。结果 侵袭性曲霉菌病是抑制患者的常见感染类型,诊断应综合临床、实验室结果、影象学及病理结果。结论 侵袭性曲霉菌病死亡率高,存在危险因素的患者应早期开始经验性抗真菌治疗。     

Resource use and cost of treatment with voriconazole or conventional amphotericin B for invasive aspergillosis

BACKGROUND: Voriconazole, a broad-spectrum triazole, has demonstrated significantly improved survival compared with conventional amphotericin B (CAB) as initial therapy for invasive aspergillosis (IA). OBJECTIVE: To compare health care resource use and cost at 12 weeks following first-line treatment with voriconazole compared with CAB for IA using resource use data collected during a clinical trial. METHODS: Days of hospitalization, intensive care, antifungal drug use, and outpatient care were collected during a large randomized, controlled trial of patients with IA receiving initial treatment with voriconazole or CAB. Unit costs based on published data sources were applied to healthcare use to estimate 12-week costs following initiation of therapy. Resource use and costs were compared for each treatment arm overall and by survival. The sensitivity of total costs to changes in healthcare use and unit costs was examined. RESULTS: Total hospital days and intensive care unit (ICU) days were similar for voriconazole and CAB (total: 27.8 vs. 27.7, P=0.97 and ICU: 5.6 vs. 8.1, P=0.11). Among survivors, voriconazole was associated with similar numbers of total hospital days (29.8 vs. 32.0 days, P=0.54) to CAB, but fewer ICU days (3.9 vs. 8.2, P=0.03). For non-survivors, those treated with voriconazole had a similar number of total hospital days (23.0 vs. 21.8, P=0.73) and ICU days (9.8 vs. 7.9, P=0.44). Patients treated with voriconazole had significantly more days alive and out of the hospital than with CAB at 12 weeks (40.3 vs. 28.4 days, P<0.001). Total costs were similar with voriconazole compared with CAB ($78,860 vs. $83,857, P=0.51). Differences in cost were not sensitive to changes in the input parameter values. CONCLUSIONS: Using voriconazole first-line for treatment of IA resulted in significantly fewer deaths and similar treatment costs. Hospital-free survival was significantly greater for patients initially treated with voriconazole.     

Liposomal amphotericin B compared with amphotericin B deoxycholate in the treatment of documented and suspected neutropenia-associated invasive fungal infections

It has been suggested that a better outcome of neutropenia-associated invasive fungal infections can be achieved when high doses of lipid formulations of amphotericin B are used. We now report a randomized multicentre study comparing liposomal amphotericin B (AmBisome, 5 mg/kg/d) to amphotericin B deoxycholate (AmB, 1 mg/kg/d) in the treatment of these infections. Of 106 possible patients, 66 were enrolled and analysed for efficacy: nine had documented fungaemia, 17 had other invasive mould infections and 40 had suspected pulmonary aspergillosis. After completion of the course medication, in the AmBisome group ( n  = 32) 14 patients had achieved complete response, seven a partial response and 11 were failures as compared to 6, 13 and 15 patients ( n  = 34) treated with AmB ( P  = 0.09); P  = 0.03 for complete responders. A favourable trend for AmBisome was found at day 14, in patients with documented infections and in patients with pulmonary aspergillosis ( P  = 0.05 and P  = 0.096 respectively). Mortality rates were lower in patients treated with AmBisome (adjusted for malignancy status, P  = 0.03). More patients on AmB had a >100% increase of their baseline serum creatinine ( P  < 0.001).
The results indicate that, in neutropenic patients with documented or suspected invasive fungal infections AmBisome 5 mg/kg/d was superior to AmB 1 mg/kg/d with respect to efficacy and safety.     

Safety and efficacy of caspofungin and liposomal amphotericin B, followed by voriconazole in young patients affected by refractory invasive mycosis

OBJECTIVE: Data on the use of combination of liposomal amphotericin B and caspofungin followed by voriconazole, as maintenance or further rescue treatment, in 10 patients with invasive mycosis are reported. MATERIAL AND METHODS: The diagnoses were acute leukemia (7), myelodysplastic syndrome (1) and Hodgkin's lymphoma (1). All patients developed an invasive mycosis (proven, 3; probable, 6; and possible, 1) refractory to first-line antifungal treatment (liposomal amphotericin B in all patients except one who received fluconazole). RESULTS: Rescue therapy with a combination of caspofungin and liposomal amphotericin B was well tolerated, hypokalemia, and thrombophlebitis being the most common side-effects. Combination therapy was administered for a median of 17 d, range 6-40. Among the nine patients with proven or probable mycosis, one was not evaluated because of early death caused by massive hemoptysis whilst in the remaining eight patients, the response was classified as complete, stable and failure in four, three, and one patients, respectively. Complete response was also observed in patient with possible mycosis. Eight of nine patients received voriconazole for a median of 75 d, range 42-194. Voriconazole was well tolerated although some drug interactions were observed during treatment with methotrexate and digoxin. After a median follow-up of 125 d, nine of 10 patients are alive. Overall, a favorable response to antifungal treatment (including the case of possible mycosis) was obtained in eight of 10 patients. CONCLUSION: These data suggest that medical antifungal treatment may be intensified in severely ill patients without significantly compromising patient safety. The combination of synergistic antifungal drugs as well as their sequential use warrants further investigation by a larger randomized controlled study.     

COPD并发肺动脉高压与Rho激酶表达的相关性分析

目的分析老年COPD患者并发肺动脉高压与血清Rho激酶表达的相关性。方法分析我院接受治疗的COPD患者的临床资料。依据患者是否合并肺动脉高压分为观察组、对照组。结果共纳入观察组38例,对照组40例。观察组患者肺动脉平均压、血清ROCK1、单核细胞ROCK1、肿瘤坏死因子α及C-反应蛋白水平均显著高于对照组(P0.001)。观察组患者血清ROCk1水平与肺动脉高压呈现显著性正相关(P0.001)。观察组患者单核细胞ROCk1水平与肺动脉高压呈现显著性正相关(P=0.004)。结论合并肺动脉高压的老年COPD患者,外周血及单核细胞内ROCK1表达均升高,且与肺动脉平均压力呈现正相关。提示ROCK1是干预COPD向肺动脉高压进展的新靶点。     

两性霉素B对老年白血病化疗后肺部侵袭性真菌感染的疗效研究

目的探讨两性霉素B对老年白血病化疗后肺部侵袭性真菌感染患者的临床治疗效果。方法选取我院自2014年1月至2015年7月收治的65例白血病化疗后发生肺部侵袭性真菌感染的患者作为研究对象,随机的分为研究组35例,对照组各30例,研究组患者给与两性霉素B进行治疗,对照组患者给与米卡芬净进行治疗,观察两组患者的临床疗效和不良反应发生情况。结果治疗后研究组临床总有效率为85.71%(30/35),患者G试验转阴率为89.28%(25/28),对照组为56.67%(17/30),G试验转阴率为76.00%(19/25),组间比较差异显著(P0.05),具有统计学意义;两组患者不良反应发生率比较差异不显著(P0.05)。结论可选择两性霉素B对老年白血病化疗后肺部侵袭性真菌感染的患者进行治疗,其效果显著,经济性较高,可推广使用。     

Successful treatment with micafungin of invasive pulmonary aspergillosis in acute myeloid leukemia,with renal failure due to amphotericin B therapy

Invasive aspergillosis is an important factor in the morbidity and mortality of patients suffering from hematologic disorders treated with chemotherapy. Treatment with amphotericin B is often limited because of toxicity, particularly nephrotoxicity. We describe a case of invasive pulmonary Aspergillus fumigatus infection in acute myeloid leukemia with renal failure due to amphotericin B therapy, which responded to treatment with a new antifungal agent, micafungin. Micafungin appears to be an effective and safe therapy for Aspergillus infections with renal failure due to amphotericin B.     

老年慢性阻塞性肺疾病合并肺结核的早期诊断及治疗探讨

目的分析住院老年人慢性阻塞性肺疾病（COPD）合并肺结核的临床特点,探讨其早期诊断及治疗措施。方法对48例住院老年COPD合并肺结核患者的临床资料进行回顾性分析。结论老年COPD合并肺结核的临床症状、体征、影像学及辅助检查均不典型,且合并症、并发症多,漏诊、误诊率高。应引起临床医师的高度重视,以早期诊断,及时治疗。     

COPD合并肺动脉高压诊治分析

目的 探讨COPD合并肺动脉高压临床诊断,常规COPD治疗与强调戒烟和氧疗疗效对比.方法本研究随机选取我院就诊确诊为COPD合并肺动脉高压的患者90例为研究对象,随机分为对照组和实验组A、B,对照组仅针对COPD进行规范化治疗,实验组A采取常规的COPD系统化治疗外还特别强调戒烟,实验组B在实验组A治疗的基础上加上无创正压通气治疗.处理6周后,观察肺动脉压的动态变化情况和动脉血气分析情况.结果 实验组A及实验组B对改善肺动脉高压及患者动脉血气上明显高于对照组,P〈0.05.实验组B与实验组A相比,患者肺动脉压降低明显,P〈0.05.结论 规范治疗COPD对COPD合并肺动脉高压患者有很好的疗效,正压通气治疗及戒烟能明显增加患者疗效,改善患者预后.     

醒脑静联合无创通气治疗 COPD 合并肺性脑病的临床分析简

目的 观察醒脑静注射液合并无创机械通气（BiPAP）治疗慢性阻塞性肺疾病（COPD）合并肺性脑病的疗效.方法 将60例患者随机分为对照组和治疗组,每组30例,两组均予以常规抗炎化痰平喘和无创通气治疗,治疗组加用醒脑静注射液.比较两组72 h临床症状、格拉斯哥（GCS）评分、血气分析、气管插管率、住院时间及血流动力学变化.结果 治疗组与对照组相比,总有效率、血气分析、格拉斯哥（GCS）评分及住院时间均有显著差异（P〈0.05）;两组血流动力学指标比较无统计学意义（P〉0.05）.结论 醒脑静与无创通气联合治疗COPD合并肺性脑病具有良好效果.