急性肾衰竭继发真菌感染患者临床特点及诊治分析

目的探讨急性肾衰竭患者继发真菌感染的临床特点，总结诊治经验。方法回顾性分析我院肾内科2007年3月至2009年7月间收治的10例急性肾衰竭继发真菌感染患者临床资料，总结其临床特点。结果（1）10例患者中，男5例、女5例，年龄69-84岁，平均（78．9±4．7）岁。基础疾病数：2～5个／例，平均（3．9±1．2）个／例，其中糖尿病肾脏病6例，系统性血管炎2例，慢性肾炎1例，高血压肾病1例。血液透析10例，使用激素3例。抗生素种类：平均（3．2±2．3）种／例，亚胺培南使用率100％。（2）真菌感染情况：肺曲菌病3例，念珠菌败血症2例，霉菌败血症1例，肺念珠菌感染4例，尿霉菌孢子1例，粪霉菌孢子5例。确定深部真菌感染的时间为（22．6±11．1）d。（3）10例患者中死亡5例。存活组与死亡组比较，诊断天数、两性霉素B、游离甲状腺素（FT4）、射血分数（EF）、HCO3^-值比较，差异具有统计学意义。结论急性肾衰竭继发真菌感染患者以糖尿病多见，粪、尿常规检查中发现定植霉菌可能是深部真菌感染的信号。

Clinical features,diagnosis and treatment of fangal infection-induced acute renal failure

Objective To analyze the etiology, clinical ieatures, treatment expemence oi fungal infection in patients with acute renal failure（ARF）. Methods The clinical data of 10 patients with fungal infection induced ARF were retrospectively analyzed,and their clinical characteristics summarized. Results There were 5 males and 5 females with mean age being（78. 9 ± 4. 7） years. There were more than three primary diseases every patient on average, including diabetes mellitus accounting for 60%. The pathogens of fungal infection were as follows： lung aspergillosi（3 cases）, candidaemia （2 cases）, unidentified mysos sepsis（ 1 case）, candida pneumonia（4 cases）. There was high fungus positive rate in urine and feces before diagnosis of fungual infections. The survival rate and mortality was 50% respec- tively. Bacteria positive rate of urine and sputum was significantly higher in death group than in survival group. HCO3 - was different in death group and in sunival group. Conclusions In acute renal failure, fungal infections are common with various etiologies and clinical manifestations. It may be a signal of fungal infections that fungal spores are examined in urine or feces.