摘要
目的探讨恶性肿瘤患者放疗后侵袭性真菌病(IFD)的发病率、发病时间及危险因素,为IFD临床诊治提供参考。方法采用回顾性调查方法,收集山东省医学科学院附属医院2017年11月-2019年4月期间行放疗的345例患者的性别、年龄、原发病诊断、合并良性基础疾病等一般资料及诊治情况,疑似出现侵袭性真菌病的患者进行影像学、血清学、微生物学检查及组织病理学检查并进行统计学分析。结果 345例恶性肿瘤患者放疗后发生IFD29例次,其中确诊6例次,临床诊断11例次,拟诊12例次,总体发生率为8.4%。平均IFD发生时间为放疗开始后(36.8±25.41)d。共真菌15例次(其中念珠菌10例次,曲霉菌5例次),标本分别来源于外周血或骨髓5例,痰或呼吸道灌洗液9例,活组织标本1例。在未明确病原体的病例中,有1例GM试验阳性,G试验阳性、GM试验阴性1例,未检出隐球菌及肺孢子菌感染者。肺癌、合并基础疾病、出现重度粒细胞缺乏、使用广谱抗菌药物是IFD发生高危因素(P值分别为0.039、0.005、0.001、0.047)。结论 IFD临床诊断困难,对于存在高危因素的恶性肿瘤放疗后疑似患者,应及时采取相应措施,降低感染发生率,保证患者治疗效果。
Objective To investigate the incidence and timing of and risk factors for invasive fungal disease(IFD)in patients with malignant tumors after radiotherapy in order to provide a reference for clinical diagnosis and treatment of IFD.Methods A retrospective study was conducted.General information(such as gender,age,primary diagnosis,and benign underlying condition)and diagnostic and treatment information were collected for 345 patients who received radiotherapy at the Hospital Affiliated with the Shandong Academy of Medical Sciences from November 2017 to April 2019.Imaging,serology,microbiology,and histopathology results for patients suspected of having an IFD were statistically analyzed.Results Of 345 patients,29 had an IFD.The IFD was definitively diagnosed in 6,clinically diagnosed in 11,and prospectively diagnosed in 12,with an overall incidence of 8.4%.The average timing of an IFD was 36.8±25.41 days after the beginning of radiotherapy.Fungi were detected in 15 patients,including 10 with Candida and 5 with Aspergillus.Specimens were from peripheral blood or bone marrow of 5 patients,sputum or lavage fluid from the respiratory tract of 9,and from a biopsy in 1.Of the patients with unidentified pathogens,1 tested positive according to the GM test,and 1 tested positive according to the G test and negative according to the GM test.Cryptococcus and pneumocystis infections were not noted.Lung cancer,an underlying condition,severe agranulocytosis,and the use of broad-spectrum antibiotics were high-risk factors for development of an IFD(P value=0.039,0.005,0.001,and 0.047).Conclusion The clinical diagnosis of an IFD is difficult.Corresponding measures should be promptly taken to reduce the incidence of infection and ensure that treatment is effective in high-risk patients after radiotherapy.
作者
王文辉
梁雪峰
韩春燕
尉若川
辛江泽
冯斌
张振
WANG Wen-hui;LIANG Xue-feng;HAN Chun-yan;WEI Ruo-chuan;XIN Jiang-ze;FENG Bin;ZHANG Zhen(Hospital Affiliated with the Shandong Academy of Medical Sciences,Shandong First Medical University,Jinan,China 250031)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第11期1351-1353,1357,共4页
Journal of Pathogen Biology
基金
山东省医学科学院医药卫生科技创新工程
关键词
侵袭性真菌病
临床特点
免疫损伤
危险因素
Invasive fungal disease
clinical characteristics
immune damage
risk factors
