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目的探究艾滋病(AIDS)合并马尔尼菲青霉病(PSM)的感染率,以及常规实验室检查结果和5种抗真菌药物对马尔尼菲青霉菌(PM)的体外抗菌活性。方法 2006年1月2009年11月间确诊AIDS患者326例,从其血液、骨髓培养出65株PM,检测该65例患者的血常规、肝功能和肾功能,并对20株酵母相PM进行体外药敏进行分析。结果 AIDS合并PSM的感染率为19.94%;外周血常规:WBC<4.0×109/L者48例,HB<100g/L者51例,PLT<100×109/L者46例。肝功能检查:ALT>40U/L者49例,AST>40U/L者51例,GGT>60U/L者44例,ALP>150U/L者36例,ALB<35g/L者53例,A/G倒置者50例。肾功能检查:BUN>7.2mmol/L者9例,Cr>150μmol/L者4例。20株酵母相PM对5-氟胞嘧啶(5FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分别为75%、90%、80%、90%、90%。结论 AIDS合并PSM感染率较高;患者感染后外周血WBC、HB、PLT通常低于正常人,肝功能多表现异常,肾功能的改变较少;对PM的治疗以AMB、ITR、VRC为首选。
Objective To investigate the infection rate of AIDS combined with Penicillium marneffei (PSM) and the results of routine laboratory tests and in vitro antibacterial activity of five antifungal agents on Penicillium marneffei (PM). Methods Thirty-six AIDS patients were diagnosed from January 2006 to November 2009 with 65 PMs from their blood and bone marrow. The blood, liver and renal function of the 65 patients were detected and 20 yeast phases PM In vitro susceptibility analysis. Results The infection rate of AIDS complicated with PSM was 19.94%. The peripheral blood routine: 48 cases with WBC <4.0 × 109 / L, 51 cases with HB <100g / L and 46 cases with PLT <100 × 109 / L. Liver function tests: ALT> 40U / L in 49 cases, AST> 40U / L in 51 cases, GGT> 60U / L in 44 cases, ALP> 150U / L in 36 cases, ALB <35g / L in 53 cases, A / G inverted in 50 cases. Renal function tests: BUN> 7.2mmol / L in 9 cases, Cr> 150μmol / L in 4 cases. The sensitivities of 20 strains of yeast PM to 5FC, AMB, FCA, ITR and VRC were 75% 90%, 80%, 90%, 90%. Conclusion The prevalence of AIDS complicated with PSM is high. The WBC, HB and PLT in peripheral blood are usually lower than those in normal people after infection. The abnormal liver function and the change of renal function are less. The treatment of PM with AMB, ITR and VRC is the first choice .