中国大陆地区曲霉病流行现状分析

摘要/Abstract

摘要： 目的了解中国大陆地区曲霉病流行状况及诊治现状。方法通过CNKI及Pubmed搜索1991年来中国大陆地区曲霉病及曲霉相关文献,进行数据统计和总结。结果 1991年1月-2009年10月报道曲霉病1457例,其中481例有病原学证据,258例进行菌种鉴定,其中烟曲霉153例。感染部位最常见于肺,为1047例。病原学诊断依据主要是镜检和培养;菌种鉴定主要依赖形态学特征,仅4例进行分子生物学鉴定;仅少数进行半乳甘露聚糖及葡聚糖检测;体外药敏试验少,仅报道2株黄曲霉对两性霉素B耐药,2株烟曲霉多药耐药。伊曲康唑为侵袭性曲霉感染经验治疗(抢先治疗)的首选药物。过敏性支气管肺曲霉病则多单用糖皮质激素或联合伊曲康唑,大部分慢性及腐生型曲霉病及鼻窦曲霉病患者行手术治疗。结论中国大陆地区曲霉病流行趋势与国际一致,非烟曲霉感染有所增加,感染部位仍以肺为主。应提高菌种形态学和分子生物学鉴定水平,积极开展非培养检测手段,保证正确和及时地诊断;加强药敏监测,为临床治疗提供有效信息。

关键词: 曲霉病, 菌种鉴定, 诊断, 药敏, 治疗

Abstract: Objective To understand the epidemiology of aspergillosis and the status of diagnosis and treatment in mainland China.Methods Literatures from January 1991 to October 2009 were collected by CNKI and Pubmed and statistically analyzed.Results A total of 1 447 cases were included in our study,in which 481 cases had microbiological evidences of aspergillus,258 cases did species identification with 153 strains of A.fumigatus.Pulmonary infection was presented in 1 047 cases.Etiological diagonosis depended on direct microspcopy and culture,while species identification relied on morphology except 4 cases with identification of molecular biology.G-test and GM-test were performed in few cases and in vitro susceptibility test was fewer.Only 2 strains of A.flavus were resistant to AMB and 2 strains of A.fumigatus were resistant to multidrugs.Itraconazole pretended to be the first choice for invasive aspergillosis.Corticosteroid alone or combined with itraconazole was applied to allergic bronchopulmonary aspergillosis.Surgical excision was recommended for chronic,saprophytic,nasal and paranasal sinus aspergillosis.Conclusions Trend of aspergillosis in mainland China was in concordance with the world.Mobidity of non-fumigatus aspergillosis increased,especially pulmonary involvements.Morphological and molecular biological identification are important for accurate and prompt diagnosis.In vitro susceptibility test is helpful for clinical treatment.

Key words: aspergillosis, species identification, diagnosis, in vitro susceptibility

中图分类号:

R519

高露娟, 余进, 李若瑜. 中国大陆地区曲霉病流行现状分析[J]. 中国真菌学杂志, 2010, 5(4): 247-251.

GAO Lu-juan,YU Jin,LI Ruo-yu. Epidemiology of aspergillosis in mainland China[J]. Chinese Journal of Mycology, 2010, 5(4): 247-251.

参考文献

[1] Caston-Osorio J J,Rivero A,Torre-Cisneres J.Epidemiology of invasive fungal infection[J] Int J Antimicrob Agents,2008,32Suppl 2:S103-S109.
[2] Geiser D M,Klich M A,Frisvad J C.The current status of species recognition and identification in Aspergillus[J] Stud Mycol,2007,59:1-10.
[3] 朱红梅.曲霉病的诊断与治疗[J] 中国真菌学杂志,2008,3(3):170-175.
[4] 张镭,赵伟,金铭鑫.鼻窦真菌感染分析[J] 中华医院感染学杂志,2008,18(10):1492-1493.
[5] Xie L,Zhong W,Shi W.Spectrum of fungal keratitis in north China[J] Ophthalmology,2006,113(11):1943-1948.
[6] Balajee S A,Houbraken J,Verweij P E.Aspergillus species identification in the clinical setting[J] Stud Mycol,2007,59(5):39-46.
[7] Kang E X,Wu J Y,Wang G Y.Cutaneous and eyes Aspergillus fumigatus infection[J] Chin Med J(Engl),2008,121(22):2366-2368.
[8] 李东明,修典荣,李若瑜,等.我国首例肌曲霉病及其试验研究[J] 中国真菌学杂志,2007,2(4):193-195.
[9] 尹斌,曹泸丹,王倩,等.下肢深静脉血栓形成继发溃疡性皮肤曲霉菌病1例[J] 中国真菌学杂志,2009,4(1):35-38.
[10] 李发增,冉玉平,代亚玲,等.土曲霉致双外耳道曲霉病[J] 中国真菌学杂志,2007,2(3):129-132.
[11] 唐晓丹,李光辉.曲霉病的治疗:美国感染病学会临床实用指南[J] 中国感染与化疗杂志,2008,8(3):161-166.
[12] De Pauw B,Walsh TJ,Donnelly JP.Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group(EORTC/MSG)consensus group[J] Clin Infect Dis,2008,46(12):1813-1821.
[13] 中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J] 中华内科杂志,2006,45(8):697-700.
[14] 冯芳,尹有宽.陈一东,等.肺曲霉菌感染21例临床分析[J] 华西医学,2008,23(6):1315-1316.
[15] 冯长顺,林海丽.郭丽娟.17例肺曲霉菌病临床分析[J] 中华医院感染学杂志,2006,16(10):1119-1121.
[16] 陈敏.肺结核继发曲菌病38例临床分析[J] 现代中西医结合杂志,2006,15(21):2962-2963.
[17] 徐明珠,孙爱宁,吴德沛,等.血清半乳甘露聚糖抗原检测对血液病患者侵袭性肺曲霉病的诊断及预后的价值[J] 中国感染与化疗杂志,2009,9(3):233-236.
[18] Odabasi Z,Mattiuzzi G,Estey E.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections:validation,cutoff development,and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome[J] Clin Infect Dis,2004,39(2):199-205.
[19] 张珺辉.肺真菌感染的诊断与治疗进展[J] 中国全科医学,2005,8(24):2010-2012.
[20] 陈灏珠.实用内科学[M] 第12版.北京:人民卫生出版社,2005:1687-1688.
[21] Rosenberg M,Patterson R,Mintzer R.Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis[J] Ann Intern Med,1977,86(4):405-414.
[22] 徐凌,蔡柏蔷,徐凯峰,等.变态反应性支气管肺曲菌病23例分析[J] 中华内科杂志,2007(3):208-212.
[23] 饶会林,方浩徽,牛华,等.变态反应性支气管肺曲菌病20例临床分析[J] 临床肺科杂志,2008,13(12):1574-1575.
[24] 李德容,钟淑卿,陈国勤,等.慢性坏死性肺曲霉病18例临床分析[J] 中国真菌学杂志,2006,11(5):260-263.
[25] 郑玉龙,王雪芬,丁伟,等.慢性坏死性肺曲霉病的诊断与治疗[J] 中华结核和呼吸杂志,2006,29(2):92-95.
[26] Saraceno J L,Phelps D T,Ferro T J.Chronic necrotizing pulmonary aspergillosis:approach to management[J] Chest,1997,112(2):541-548.
[27] 沈卫.慢性坏死性肺曲霉病15例临床分析[J] 中国血液流变学杂志,2008,18(4):549-550.
[28] 刘伟,万喆,陈伟,等.对多烯类药物耐药的1株黄曲霉临床株耐药性的初步研究[J] 中国真菌学杂志,2007,2(3):133-136.
[29] Zhang QQ,Li L,Zhu M.Primary cutaneous asporgillosis due to Aspergillus flavus:a case report[J] Chin Med J(Engl),2005,118(3):255-257.
[30] Li D M,Xiu D R,Li R Y.Aspergillus flavus myositis in a patient after liver transplantation[J] Clin Transplant,2008,22(4):508-511.
[31] 张国荣,周午琼.烟曲霉引起肺部感染致患者死亡2例[J] 中国微生态学杂志,2005,17(6):474.
[32] 乔建军,刘伟,万喆,等.米卡芬净对分离自中国的念珠菌和曲霉临床株体外抑菌活性的研究[J] 中国真菌学杂志,2007,2(1):5-10.
[33] 周铁丽.彭婷婷,李玉萍,等.肺部曲霉菌属感染的临床与耐药性研究[J] 中华医院感染学杂志,2007,17(10):1309-1311.
[34] 中华内科杂志编辑委员会.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)[J] 中华内科杂志,2007,46(7):607-610.
[35] Caillot D,Bassaris H,Megecr A.Intravenous itraconazole followed by oral itraconazole in the treatment of invasive pulmonary aspergillosis in patients with hematologic malignancies,chronic granulomatons disease,or AIDS[J] Clin Infect Dis,2001,33(8):e83-e90.
[36] Caillot D.Intravenous itraconazole followed by oral itraconazole for the treatment of amphotericin-B-refractory invasive polmonary aspergillosis[J] Acta Haematol,2003,109(3):111-118.
[37] 胡爱荣,张静静.慢性重型病毒性肝炎合并曲霉病的临床分析[J] 中华医院感染学杂志,2008,18(2):207-209.
[38] 田沂,唐晓鹏,罗开忠.重型肝炎合并侵袭性肺曲霉病9例分析[J] 中华肝脏病杂志,2005,13(9):643.
[39] 李发增,冉玉平,代亚玲,等.土曲霉致双外耳道曲霉病[J] 中国真菌学杂志,2007,2(3):129-132.
[40] Wark P A,Hensley M J,Saltos N.Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis:a randomized controlled trial[J] J Allergy Clin Immunol,2003,111(5):952-957.
[41] 车春利,霍建民,桑玉兰.纤维支气管镜下微波联合药物治疗肺部曲菌球病的临床研究[J] 中国内镜杂志,2006,12(6):611-613.
[42] 冯立人,郭庆明.非侵袭性上颌窦曲荫病43例临床分析[J] 中国耳鼻咽喉颅底外科杂志,2001,7(4):226-228.
[43] 高明阳,侯玉凡,管迎新,等.伊曲康唑治疗鼻曲霉病一例[J] 中华皮肤科杂志,2000,33(5):352.
[44] 单葵,李桂明.伊曲康唑针剂治疗蝶窦曲霉感染1例[J] 皮肤病与性病,2006,28(2):60-61.