造血系统恶性疾病医院深部真菌感染临床分析

目的 探讨造血系统恶性疾病患者医院深部真菌感染的临床表现、病原菌的分布、诊断及治疗措施。方法对我院血液科1998年10月～2004年9月间，经微生物学检查证实的52例造血系统恶性疾病患者医院深部真菌感染的临床资料，进行前瞻及回顾性研究。结果感染的部位依次为下呼吸道、胃肠道、泌尿道、血液等；临床表现多样性；病原菌分类前5位为白色念珠菌占57．14％，热带念珠菌21．43％，酵母菌和近平滑念珠菌各占7．14％，曲霉菌5．36％；单用制霉菌素、氟康唑、伊曲康唑和两性霉素B治疗者，治愈23例，好转12例，恶化死亡17例（32．69％）。结论近年来，造血系统恶性疾病患者医院深部真菌感染率有逐年增加的趋势；其临床表现无特异性，应警惕高危患者真菌感染的危险性；病原菌仍以白色念珠菌为主，但非白色念株菌的感染率逐渐增加，真菌感染的死亡率仍较高。

Deep Fungal Infection in Patients with Hematopoietic Malignancies: A Clinical Analysis

OBJECTIVE To investigate the manifestation,fungal spectrum,diagnosis,antifungal therapy and(outcome) of deep fungal infection(DFI) in patients with hematopoietic malignancies.METHODS Fifty-two(patients) of SFI admitted in Shandong Provincial Hospital during Oct 1998 to Sept 2004 were enrolled in this(investigation,) including 34 males and 18 females with mean age of 54 years old.Clinical data,such as manifestation,fungal(spectrum,) treatment and outcome,were observed prospectively and retrospectively.RESULTS Lower respiratory tract,gastrointestinal tract,urinary tract and blood were the main DFI infection sites by order of prevalence.The clinical manifestation was various among cases.Pathogen detection determined the subtypes of fungi were Candida albicans(57.14%),C.tropicalis(21.43%),yeast(47.14%),C.parapsilosis(7.14%),and Aspergillus((5.36%).) Nystatin,fluconazole,flucytosine,and(amphotericin) B were used alone or in(combination) to treat DFI.The rates of curing,improvement and death were 44.23%,23.08% and 32.69%,(respectively).(Among) 52 cases,25(48.08%) were occurred during Oct 2002 to Sept 2004,compared with 27((51.92%)) during Oct 1998 to Sept 2002,suggested the elevated incidence of DFI.CONCLUSIONS The incidence of DFI in patients with hematopoietic malignancies is increasing these years.The clinical manifestation of DFI may be nonspecific.It is critical to pay more attention to the fungal infection among the high-risk patients,therefore fungus detection from various(samples) should be recommended for the sake of early diagnosis of DFI. Though(C.albicans) remains the top in pathogen spectrum analysis,infection of other fungi tends to increase.The mortality of DFI is still very high thus more investigations about early diagnosis and treatment of DFI should be conducted.