【作者】 穆艳顺；

【导师】 张宝玺；

【作者基本信息】 河北医科大学 ， 儿科学， 2009， 硕士

【摘要】 目的:近年研究表明,由于长期使用广谱抗生素、化疗药物、免疫抑制剂和造血干细胞移植的增加,使恶性血液病患者侵袭性真菌感染的发病率逐渐增加,侵袭性真菌感染已成为恶性血液病患者的常见并发症及致死原因。由于真菌感染症状的非特异性和临床表现的多样性,同时抗真菌药物毒副作用较大,且价格较昂贵,给侵袭性真菌感染诊断和治疗带来很大困难。通过文献综述总结恶性血液病患者侵袭性真菌感染的病原学和流行病学、易患因素、临床特征、检测方法、诊断过程和治疗药物。方法:应用CNKI中文数据库、中国生物医学文献数据库、PubMed和Highwire press外文全文数据库进行文献的检索。结果:恶性血液病患者患者侵袭性真菌感染的病原菌主要为念珠菌,曲霉菌;发病率在全球范围内迅速增加;恶性血液病患者侵袭性真菌感染的易患因素为疾病本身存在免疫缺陷和治疗因素如细胞毒药物,免疫抑制剂和抗生素的应用;恶性血液病患者侵袭性真菌感染中以呼吸系统真菌感染最常见;其次为中枢神经系统和消化系统;恶性血液病患者侵袭性真菌感染的病原学检测方法有形态学检查、血清学检查、分子生物学检查;恶性血液病患者侵袭性真菌感染的诊断依据宿主因素、临床表现、微生物资料进行分层诊断分别为确诊、临床诊断、拟诊;治疗原则分为预防治疗、经验性治疗、临床诊断治疗、确诊后治疗和联合治疗。抗真菌药物如两性霉素B脂质体、新一代咪唑类和棘白菌素类使抗真菌效果有了明显提高。结论:1恶性血液病患者侵袭性真菌感染的病原菌主要为念珠菌,曲霉菌,发病率在全球范围内迅速增加,感染部位主要是呼吸系统。2真菌的检测方法依据形态学、血清学及分子生物学检查。3诊断依据宿主因素、临床表现、微生物资料分层诊断为确诊、临床诊断、拟诊。治疗原则分为预防治疗、经验性治疗、临床诊断治疗、确诊后治疗和联合治疗。更多还原

【Abstract】 Objective:In recent years,studies have shown that the incidence rate of invasive fungal infection in patients with haematologic malignancies have increased gradually,because of long-term use broad-spectrum antibiotics,chemotherapy drugs, immunosuppressor and hematopoietic stem cell transplant patients increasing.Invasive fungal infection has become the common complication and cause of death in patients with haematological malignancies.Invasive fungal infection has non-specificity symptom and variety of clinical manifestation, antifungal drugs have side effect and expensive in price,Which have resulted in great difficulty of invasive fungal infection diagnosis and treatment.In this paper,pathogeny epidemiology, susceptible factor,clinic characters,detecting methods,process of diagnosis and antifungal drugs of invasive fungal infection in patients with haematological malignancie were systemically reviewed.Methods:To search the documents utilizing the CNKI and CBM databases,PubMed and Highwire press database.Results:The major pathogenic fungis of invasive fungal infection in patients with haematological malignancies are Candida and aspergillus.The morbidity is greatly increasing in the world.The susceptible factor is closely related to the disease itself who exist immundeficiency and therapy factor such as the application of cytotoxic drug,immunosuppressor and broad-spectrum antibiotics.The most common site of infection is the respiratory system,followed by central nervous system and digestive system.The methods of pathogeny detecting are morphology,serology,molecular biology examination.The diagnosis of invasive fungal infection in patients with haematological malignancies was divided into three levels.They are final diagnosis,clinical diagnosis and possible diagnosis based on factor of host,clinical manifestation and microbiology criteria.Therapeutic principle may be categorized as prophy-lactic treatment,empiric treatment,clinical diagnosis treatment, final diagnosis treatment and combination therapy.The effect of several antifungal agents has improved such as lipid formulations of amphotercin B,new azoles and echinoca.Conclusions:1 The major species of fungal are candida and aspergillus of invasive fungal infection in patients with haematological malignancies.The morbidity is greatly increasing in the world. The most common site of infection was the respiratory system.2 The methods of pathogeny detection are based upon morphology,serology and molecular biology examination.3 Three levels of diagnosis are final diagnosis,clinical diagnosis and possible diagnosis of invasive fungal infection in patients with haematological malignancies.Therapeutic principle may be categorized as prophylactic treatment,empiric treatment, clinical diagnosis treatment,final diagnosis treatment and combination therapy.更多还原