【摘要】 目的探讨结缔组织病(CTD)合并侵袭性肺部真菌感染(IPFI)的临床表现、病原学特征、易感因素、治疗和预后。方法根据患者血、支气管灌洗及培真菌培养进行抗真菌治疗,并对其方法与转归进行回分析。结果 20例患者确诊2例,临床诊断13例,拟诊5例,17例患者有原发病活动。所有患者均急性起病,发热(80%)常见,可有不同程度的呼吸道症状。有10例患者并发急性Ⅰ型呼吸衰竭。合并有白细胞减少8例(40%),长期使用糖皮质激素治疗17例(85%),免疫抑制剂治疗10例(50%),使用广谱抗生素治疗12例(60%)。侵袭性操作1例(5%)。确诊曲霉菌及肺隐球菌各1例。查出白色念珠菌5例、光滑念珠菌1例及克柔念珠菌2例、毛霉菌1例,有9例患者无病原学资料。所有患者均接受抗真菌药,存活16例(80%),死亡4例(20%),其中3例患者合并有肺部间质纤维化、伴呼吸衰竭,1例患者系延迟抗真菌治疗。结论 CTD合并IPFI感染发生率高;起病急,病情重;临床症状不典型;可引起呼吸衰竭;病原菌检出机率不高,死亡率高,重视患者的宿主因素,积极的早期抗真菌治疗可有效改善预后。更多还原

【Abstract】 Objective To explore the pathogenic features,clinical spectrum,risk factors,therapy and outcome in patients with connective tissue disease(CTD) complicated with invasive pulmonary fungal infections(IPFI).Methods A review was performed of 20 CTD patients with IPFI in our hospital between Jan 2006 and Jan 2010.Results The diagnostic status could be classified as follows:2 had confirmed diagnosis,13 had clinical diagnosis,5 had suspected diagnosis.17 patients had active disease.All patients with acute onset,fever(80%) common,may have varying degrees of respiratory symptoms.10 patients had type I respiratory failure.8 patients had leucopenia,17patients had long-term use of corticosteroids,10 patients received immunosuppressants and 12 patients received broad-spectrum antibiotics and 1 patient had invasive operation.The pathogen was Cryptococcus in 1 patient,Aspergillus in 1 patient,Candida albicans in 5 cases,Candida glabrata in 1 case,Candida krusei in 2 cases,Mucor in 1 case.And 9 patients had no pathogen data.Antifungal therapy was used in all patients. Of all cases,16 survived and 4 died.Conclusion Clinicians should be alerted against CTD with IPFI,which is most frequently caused by Candida and usually highly fatal.Early diagnosis and rational treatment could improve the prognosis.更多还原