151例侵袭性真菌感染的临床特点分析

目的探讨侵袭性真菌感染（IFI）的临床特点，高危感染因素及对不同药物的治疗反应。方法采取回顾性研究探讨151例确诊为侵袭性真菌感染患者的临床特点，高危易感因素，病原学分布情况及其对不同药物治疗的反应。评估不同药物治疗IFI的临床疗效和不良反应。对相应结果应用SPSS11．0软件包进行统计分析。结果151例IFI患者中感染前使用广谱抗生素者占49．02％，粒细胞缺乏者占45．10％。感染部位以单纯呼吸道感染为主（74．17％）。确诊和临床诊断的43例患者中共分离出致病真菌43例，其中自假丝酵母菌所占比例最大（占44．19％）。伏立康唑组的总有效率与两性霉素B组比较无显著性差异（P〉0．05），但其不良反应发生率低于两性霉素B组（11．62％比63．08％，P〈0．05）。结论本组侵袭性真菌感染以念珠菌属感染为主，广谱抗生素的应用及粒细胞缺乏是侵袭性真菌感染的高危易感因素。伏立康唑的临床疗效与两性霉素B相当，但不良反应的发生率较两性霉素B少。

Clinical characteristics of 151 cases of invasive fungal infection

Objective The study is aimed to investigate the clinical features, high predisposing factors and therapeutic reactions to antifungal drug of patients with invasive fungal infection （IFI）. Methods The clinical features, high predisposing factors and pathogen distribution of 151 patients with IFI was retrospective study, and different therapeutic reactions of IFI were compared. The clinical efficacy and adverse reaction were compared as regards to different treatment. SPSS 11.0 software was applied to analyze a11 the data. Results In our single center analysis,49.02% patients received broad-spectrum antibiotics treatment and 45.10% patients had agTanulocytosis before invasive fungal infection. 74.17% infection site of IFI was pulmonary infection. 43 pathogenic fungi from 151 cases were identified and Candida albicans was the most common pathogenic fungus （44.19%）in our signal center analysis. There was no significant difference in the overall effective rates between voriconazole and amphotericin B therapies, but the adverse reac- tion rate of voriconazole group was lower in amphotericin B therapy （ 11.62% versus 63.08%, P 〈 0.05 ）. Conclusions Candida albicans is the most common pathogenic fungus in our single center analysis. Broad- spectrum antibiotics and agranulocytosis were two most predisposing factors of IFI. Voriconazole is as effectively as amphotericin B and with fewer adverse reactions in the treatment of invasive fungal infection.