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目的了解肺部真菌感染的病原谱和预后。方法根据欧洲癌症研究和治疗侵袭性真菌感染协作组(EORTC)、美国变态反应和感染性疾病协会真菌病研究组(MSG)2002年制定的定义以及血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准,将北京协和医院2002年1月至2006年6月诊断的152例肺部真菌感染患者按照统一的定义进行重新分组:确诊组38例,临床诊断组24例,拟诊组35例,定植组55例,重新分析病原谱。结果 38例确诊肺部真菌感染的患者中,肺曲霉菌感染占首位(15/38),其次为肺隐球菌感染(13/38),第三为毛霉菌和其他类型丝状真菌,而真正念珠菌肺炎少见,只有2例。临床诊断组曲霉菌和曲霉菌+念珠菌占第1位,而拟诊组以及定植组以单纯念珠菌占首位。临床诊断组病死率为58.3%,高于拟诊组(25.7%)和定植组(16.4%)。拟诊组和定植组“念珠菌肺炎”分别为28例和50例,对这78例“念珠菌肺炎”患者的预后危险因素进行分析后发现,只有急性生理和慢性病评分(APACHEⅡ)与患者的预后有关,而是否抗真菌治疗及使用何种抗真菌药物与预后无关。结论肺部真菌感染以曲霉菌占第1位,其次为隐球菌和毛霉菌,念珠菌肺炎少见。痰标本念珠菌属培养阳性作为“念珠菌肺炎”的诊断标准值得商榷。
Objective To understand the pathogenic spectrum and prognosis of pulmonary fungal infection. Methods Based on the European Association for the Study and Treatment of Invasive Fungal Infections (EORTC), the American Association for the Study of the Association of Instillation and Infectious Diseases, Mycosis, 2002 (MSG) definition and the diagnosis of invasive fungal infections in patients with blood disease / malignancy Standard 152 patients with pulmonary fungal infection diagnosed in Peking Union Medical College Hospital from January 2002 to June 2006 were re-grouped according to a unified definition: 38 cases diagnosed, 24 cases clinically diagnosed, 35 cases diagnosed, colonized Group 55 cases, re-analysis of pathogenic spectra. Results Of the 38 patients diagnosed as pulmonary fungal infection, pulmonary aspergillosis was the most common (15/38), followed by pulmonary cryptococcal infection (13/38), the third was Mucor and other types of filamentous fungi, while the true Candida pneumonia is rare, only 2 cases. Clinical diagnosis of Aspergillus and Aspergillus + Candida accounted for the first one, while the diagnosis group and colonization group accounted for the first Candida alone. The mortality of clinical diagnosis group was 58.3%, higher than that of the diagnosed group (25.7%) and colonization group (16.4%). According to the analysis of the risk factors of prognosis in these 78 cases of Candida pneumonia, we found that only APACHEⅡ (APACHEⅡ), Acute Physiology and Chronic Disease Score ) And the patient’s prognosis, and whether the antifungal therapy and the use of antifungal drugs has nothing to do with the prognosis. Conclusion Pulmonary fungal infection with Aspergillus accounted for the first place, followed by cryptococcal and Mucormycosis, rare Candida pneumonia. Candida candidiasis culture positive as “Candida pneumonia ” diagnostic criteria is questionable.