|本期目录/Table of Contents|

[1]何小庆,鲁雁秋,周怡宏,等.重庆地区56 例AIDS 合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析[J].传染病信息,2018,06:521-524.
 HE Xiao-qing,LU Yan-qiu,ZHOU Yi-hong,et al.Clinical characteristics and death risk factors analysis of 56 AIDS patients with disseminated talaromycosis marneffei in Chongqing[J].Infectious Disease Information,2018,06:521-524.
点击复制

重庆地区56 例AIDS 合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析(PDF)

《传染病信息》[ISSN:1007-8134/CN:11-3886/R]

期数:
2018年06期
页码:
521-524
栏目:
论 著
出版日期:
2018-12-30

文章信息/Info

Title:
Clinical characteristics and death risk factors analysis of 56 AIDS patients with disseminated talaromycosis marneffei in Chongqing
作者:
何小庆鲁雁秋周怡宏曾妍茗李 瑶秦圆圆陈耀凯刘 敏
400036,重庆市公共卫生医疗救治中心感染病科 (何小庆、鲁雁秋、周怡宏、曾妍茗、李瑶、秦圆圆、陈耀凯、刘敏)
Author(s):
HE Xiao-qing LU Yan-qiu ZHOU Yi-hong ZENG Yan-ming LI Yao QIN Yuan-yuan CHEN Yao-kai LIU Min*
Department of Infectious Disease, Chongqing Public Health Medical Center, 400036, China
关键词:
艾滋病马尔尼菲篮状菌临床特征死亡危险因素
Keywords:
AIDS Talaromyce marneffei clinical features death risk factors
分类号:
R519.8
DOI:
10.3969/j.issn.1007-8134.2018.06.006
文献标识码:
A
摘要:
目的 探讨AIDS 合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素。方法 回顾性分析2016 年1 月— 2018 年6 月本中心收治的56 例AIDS 合并马尔尼菲篮状菌病患者临床资料。结果 患者以男性为主(78.6%),平均年龄为 (38.23±11.23)岁,最常见临床症状为发热。CD4+ T 淋巴细胞计数均值(22.16±30.83)个/μl,其中< 50 个/μl 者51 例,占比 91.1%。患者血培养马尔尼菲篮状菌均为阳性,皮肤活检、骨髓、胸水及尿培养阳性各1 例。血清半乳甘露聚糖抗原试验(GM 试验)阳性率81.4%(35/43),血浆(1-3)-β-D 葡萄糖试验(G 试验)阳性率48.2%(27/56)。患者好转出院42 例(生存组) 占比75%,死亡 14 例(死亡组)占比25%,消化道出血、HIV RNA ≥ 105 copies/ml 为AIDS 合并播散性马尔尼菲篮状菌病患 者死亡的危险因素。结论 AIDS 合并马尔尼菲篮状菌病好发于CD4+ T 淋巴细胞计数< 50 个/μl 者,临床表现复杂多样,确诊 依赖病原学检查,早期诊断、尽早抗真菌及抗反转录病毒治疗可明显改善患者预后。
Abstract:
Objective To investigate the clinical characteristics and death risk factors of AIDS patients with disseminated talaromycosis marneffei . Methods Clinical data of 56 AIDS patients with disseminated talaromycosis marneffei treated in our center from January 2016 to June 2018 were retrospectively analyzed. Results The average age of the involved patients was (38.23±11.23) years old, mainly males (78.6%). Fever is the most common clinical symptom. The mean of CD4+ T lymphocyte count was (22.16±30.83) cells/μl, and 51 patients had CD4+ T lymphocytes of < 50 cells/μl, accounting for 91.1%. All the patients were positive for Talaromyce marneffei in blood culture, and one patient was positive for each of skin biopsy, bone marrow, pleural effusion and urinary culture. The positive rate of serum galactomannan and plasma (1-3)-β-D-glucan test were 81.4% (35/43) and 48.2% (27/56). Forty-two patients (75%) were improved and discharged, and 14 patients (25%) died. Gastrointestinal bleeding and HIV RNA ≥ 105 copies/ml were risk factors for the death of AIDS patients with disseminated Talaromycosis marneffei. Conclusions AIDS with talaromycosis marneffei is commonly seen in the AIDS patients whose CD4+ T lymphocytes are less than 50 cells/μl, and their clinical manifestations are complex. Diagnosis depends on etiological examination. Early diagnosis, early antifungal and antiretroviral treatment can significantly improve prognosis.      

参考文献/References


[1] Samson RA, Yilmaz N, Houbraken J, et al. Phylogeny and nomenclature of the genus Talaromyces and taxa accommodated in Penicillium subgenus Biverticillium[J]. Stud Mycol, 2011, 70(1):159-183.
[2] 沈银忠,卢洪洲. 艾滋病合并侵袭性真菌感染的诊治[J]. 微 生物与感染,2015,10(5):275-281.
[3] 中华医学会感染病学分会艾滋病学组. 艾滋病诊疗指南第三 版(2015 版)[J]. 中华临床感染病杂志,2015,5(8):385- 401.
[4] 蔡琳,周锐峰,朱迎春,等. 艾滋病合并马尔尼菲青霉菌 病17 例临床分析[J]. 现代预防医学,2012,39(22):6051- 6053,6058.
[5] 张国丽,苏慧勇,杨磊,等. 36 例AIDS 合并播散性马尔尼 菲青霉菌病临床分析[J]. 传染病信息,2015,28(6):369- 371.
[6] 李芳,耿文奎,邓晓军,等. 艾滋病合并马尔尼菲青霉菌 病患者死亡危险因素分析[J]. 中国临床新医学,2012, 5(5):423-427. 表5 影响AIDS 合并播散性马尔尼菲篮状菌病患者死亡危险因素的Logistic 单因素分析 Table 5 Logistic univariate analysis of hospitalization outcome risk factors in AIDS patients with disseminated talaromycosis marneffei
[7] 贺莉雅,覃静林,符淑莹,等. 马尔尼菲蓝状菌病研究现状[J]. 皮肤科学通报,2017,34(5):581-588.
[8] 吴念宁,邹俊,农影星,等. 艾滋病合并播散型马尔尼菲青 霉菌病患者危险因素分析[J]. 中华临床医师杂志(电子版), 2012,6(15):4429-4431.
[9] 何凯茵,冯理智,梁志伟,等. 血清半乳甘露聚糖试验在诊 断艾滋病合并马尔尼菲青霉菌病中的价值探讨[J]. 广州医 科大学学报,2016,44(3):21-24.
[10] 陈媛媛,刘旭辉,侯明杰,等. 58 例艾滋病合并马尔尼菲 青霉菌病病人临床特征分析[J]. 中国艾滋病性病,2018, 24(1):30-32,52.
[11] 叶萍,孔晋亮,吴聪,等. 不同方案治疗马尔尼菲青霉病的 疗效分析[J]. 中华医院感染学杂志,2016,26(18):4128- 4131.
[12] Ouyang Y, Cai S, Liang H, et al. Administration of voriconazole in disseminated Talaromyces (Penicillium) marneffei infection: a retrospective study[J]. Mycopathologia, 2017, 182(5-6):569- 575.

备注/Memo

备注/Memo:
[ 基金项目] “十三五”国家科技重大专项课题(2018ZX10302104- 001,2017ZX10202101-004-008,2017ZX10201101-001-011); 重庆市2018 年科卫联合医学科研项目(2018QNXM012)
[ 作者单位] 400036,重庆市公共卫生医疗救治中心感染病科 (何小庆、鲁雁秋、周怡宏、曾妍茗、李瑶、秦圆圆、陈耀凯、刘敏)
[ 通信作者] 刘敏,E-mail: gwzxliumin@foxmail.com
更新日期/Last Update: 2018-12-30