肺结核患者合并肺部真菌感染临床相关因素分析

目的了解继发性肺结核合并真菌感染临床特点及相关影响因素。 方法回顾性分析1996年—2006年期间508例继发性肺结核合并真菌感染患者的菌株类型、临床特点及相关因素。结果1.继发性肺结核无论单一真菌感染还是混合感染,均以白色念珠菌感染为多见(分别为62%和72%)。2.继发性肺结核无论单一真菌感染还是混合感染，均以高龄（分别为49%和55%）和长病程（分别为56%和65%）为多见。3.无论单一真菌感染还是混合感染，随着肺内病变的增多，真菌感染的发生率增加，以肺内病变占据>3个肺野多见，分别为61％和75％。真菌感染易发生在病变以纤维化为主的肺结核患者，分别为69％和75％。4.无论继发性肺结核患者合并单一真菌感染还是混合感染，肺内可闻及啰音者不足5%。体温超过38℃10%以下。结论继发性肺结核合并真菌感染,菌株以白色念珠菌为主, 高龄、病程长、病变重的患者是主要好发人群, 多数患者临床特征不典型。

Analysis on clinical correlated factors of pulmonary tuberculosis complicated by fungi infection

Objective To study the clinical features and the correlated factors of secondary pulmonary tuberculosis complicated by fungi infection. Methods The clinical features and types of fungi strain in 508 patients with secondary pulmonary tuberculosis complicated by fungi infection were analyzed retrospectively. Results 1. The major type of fungi infected in the patients with secondary pulmonary tuberculosis were Candida albicans whether infected with single type or mixed type of fungi（62% and 72% ,respectively）. 2. Patients with old age and long history were the major cases with secondary pulmonary tuberculosis whether infected with single type or mixed type of fungi（49% single and 55% mixed infection in elderly patients, 56% single and 65% mixed infection in long history patients）. 3. Whether infected with single type or mixed type of fungi, the incidence of fungi infection increased with the increase of lung lesion areas, especially lesion areas were more than three lung fields（61% and 75%, respectively）. The patients with pulmonary tuberculosis complicated with fibrosis were easily infected by fungi（69% and 75% ,respectively）. 4. Whether infec- ted with single or mixed type of fungi in patients with secondary pulmonary tuberculosis, Rale and moderate anaemia were seen in up to 50% patients and moderate fever was in up to 10% patients. Conclusions Candida albicans was the major type of infected fungi in patients with secondary pulmonary tuberculosis. Patients with old age, long history and severe illness are major suspected population. The clinical features of most patients are atypical. The incidence of mixed infection with fungi in patients with secondary pulmonary tuberculosis is higher than that of patients with community acquired pneumonia.