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目的探讨我院近3年曲霉菌感染的临床表现、诊断及治疗方法。方法对2005年01月至2007年12月间经微生物学检查证实的30例曲霉菌感染患者的临床资料进行回顾性分析。结果在30例曲霉菌感染的病例中有20例为肺部感染,其中治愈2例、好转6例、死亡12例(病死率60%);胆道感染1例,泌尿道感染1例,血流感染8例。所有病例均有基础疾病,以移植术后(8例)、神经系统疾病(6例)、风湿性疾病(5例)、血液病(7例)以及原发肺部疾病(4例)最多见;其感染的常见诱因有长期使用广谱抗生素(21例)或糖皮质激素(9例)及免疫抑制剂(7例)、化疗(9例)、气管切开或气管插管(8例)。在30例病例中有18例在微生物学检查证实曲霉菌感染之前已予以经验性抗真菌治疗,其病死率为38.9%;另12例在微生物学培养阳性后才予以抗真菌治疗,其病死率为83.3%。结论曲霉菌感染是一种严重的感染性疾病,其发病率呈上升态势,这与长期大剂量广谱抗生素、大剂量糖皮质激素以及免疫抑制剂应用、化疗等密切相关,也与检测技术的提高有关。深部曲霉菌感染以肺部感染为主,主要临床表现不典型,常见的有发热、咯血,病情进展迅速,病死率极高。随着高分辨率CT及葡聚糖试验在临床工作中的展开,曲霉菌感染拟诊确立,早期予以经验性抗真菌治疗,使得曲霉菌感染病死率较前有所下降。
Objective To investigate the clinical manifestations, diagnosis and treatment of Aspergillus infection in our hospital in recent 3 years. Methods The clinical data of 30 patients with aspergillosis confirmed by microbiological examination between January 2005 and December 2007 were retrospectively analyzed. Results Among the 30 cases of Aspergillus infection, 20 cases were pulmonary infection, of which 2 cases were cured, 6 cases improved, 12 cases died (case fatality rate 60%), 1 case was biliary tract infection, 1 case was urinary tract infection and blood flow Infection in 8 cases. All cases had underlying diseases with the most common after transplantation (8 cases), neurological diseases (6 cases), rheumatic diseases (5 cases), hematological diseases (7 cases) and primary lung diseases (4 cases) (21 cases) or glucocorticoids (9 cases), immunosuppressive agents (7 cases), chemotherapy (9 cases), tracheotomy or endotracheal intubation (8 cases) . In 30 cases, 18 cases had been treated with antifungal therapy prior to microbiological confirmation of Aspergillus infection with a mortality rate of 38.9%. The other 12 cases were treated with antifungal agents after the culture of microbiology was positive. The case fatality rate 83.3%. Conclusion Aspergillus infection is a serious infectious disease with an increasing incidence, which is closely related to the long-term high-dose broad-spectrum antibiotics, high-dose glucocorticoid and immunosuppressive agents, chemotherapy, etc., and also with the detection technology Improve related. Deep aspergillosis infection mainly to the lungs, the main clinical manifestations of atypical, common fever, hemoptysis, the rapid progress of the disease, high mortality. With the development of high-resolution CT and dextran tests in clinical work, aspergillosis infection was diagnosed, and early empirical anti-fungal treatment, making Aspergillosis infection mortality decreased.