【作者】 陈晓；

【导师】 曾小峰；

【作者基本信息】 中国协和医科大学 ， 内科风湿免疫， 2006， 硕士

【摘要】 目的 探讨系统性红斑狼疮(systemic lupus erythcmatosus，SLE)合并真菌感染的易患因素、临床特征、诊断、治疗及预后。 方法 应用回顾性调查的方法对北京协和医院2000—2005年51例SLE合并真菌感染患者进行分析。 结果 1466例SLE病人中，51例合并真菌感染，发病率为3.5％。感染的常见诱因分别为长期使用糖皮质激素、免疫抑制剂、广谱抗生素，侵入性操作和白细胞减低。感染的病原菌仍以白色念珠菌为主，其次为隐球菌和曲霉菌。真菌感染最常见的部位是肺，其次为口腔、脑膜和血液。SLE合并真菌感染的临床表现无特异性，发热占90.2％，白细胞增高者占11.8％，白细胞减低者占52.9％，肺真菌感染与细菌感染和狼疮活动累及肺难以鉴别。抗真菌治疗单用氟康唑21例，两性霉素B(包括两性霉素B脂质体3例)7例，依曲康唑4例，其余均为联合用药，其中两性霉素B+5-氟胞嘧啶+氟康唑12例，先用氟康唑后换为依曲康唑2例，依曲康唑+SMZco1例。两性霉素B+氟康唑3例。本组治愈26例，好转12例，未愈3例，死亡10例，死亡率达19.6％。肺曲霉菌感染死亡率高达80％。低蛋白血症、低氧血症、多部位真菌感染、曲霉菌感染和真菌血症可能是导致死亡的危险因素。 结论 近年来真菌感染有逐年增加的趋势，与长期使用糖皮质激素、免疫抑制剂、广谱抗生素、侵入性操作的增多及白细胞减低相关。真菌感染的死亡率仍然高，尤以肺曲霉菌感染的死亡率最高(80％)，临床应重视SLE患者肺曲霉菌感染的预防、早期诊断和治疗。更多还原

【Abstract】 Objective To investigate the major predisposing factor, clinical features, diagnosis, antifungal therapy and prognosis of fungal infection (FI) in patients with systemic lupus erythcmatosus(SLE).Methods 51 cases of fungal infection in patients SLE admitted in the PUMC hospital from 2000 to 2005 were reviewed retrospectively. Results FI was found in 3.5%(51/1466) patients . The predisposing factor for FI included use of steroids/immunosuppressant/broad spectrum antibiotics over a long period, invasive manipulation and leucopenia. Candida albicans was ranked the first pathogen, thereafter were neoformans and Aspergillus species. The infective site were lung, oral cavity, cerebral meninges and blood etc. All the clinical manifestations of FI in SLE were not specific, included fever(90.2%),leucocytosis (11.8%).It was difficult to differentiate fungal infection with bacterial infection and SLE disease involved in lung. In antifungal drugs, fluconazole was used alone in 21 patients, amphotericin B in 7 patients, flucytosine in 4 patients, other patients used them in combination. Out of 51 patients, 26 were cured, 12 made improvement.The overall mortality was 19.6%( 10/51). Mortality in Aspergillus species infection was 80%(4/5). Hypoalbuminemia, hypoxia, Aspergillus species infection, and more than two infectious site might be the risk factors for mortality.Conclusion The incidence of fungal infection is increasing in recently years ,which is correlated with use of high dose steroid/immunosuppressant/ broad-spectrum antibiotics over a long period, invasive manipulation and更多还原