中国大陆地区接合菌病流行现状的回顾性分析

目的了解中国大陆地区近30 a接合菌病流行情况及诊治现状。方法通过CNKI和Pubmed数据库搜索1976年来中国大陆地区接合菌病相关文献,进行数据分析和总结。结果病例报告206篇,共428例患者。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主,其他常见感染类型为肺部、鼻眶脑和皮肤软组织。继发于糖尿病、消化道溃疡、外伤手术烧伤和其他无基础疾病患者多见。病原学诊断主要依赖镜检、培养和病理,仅35株菌鉴定至种的水平,其中6例进行分子生物学鉴定。单独系统抗真菌药物治疗为主,体外药敏试验少,两性霉素B和两性霉素B脂质体为首选用药。428例患者中共死亡126例,占发病总人数的29.43%;其中以全身播散型感染死亡率最高,占此型感染人数的83.34%。结论中国大陆地区接合菌病感染率有上升趋势。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主。应该提高形态学诊断水平,并积极开展分子鉴定,同时有条件情况下应进行菌种的体外药物敏感性检测,为临床提供更为准确的参考信息。

Epidemiology of zygomycosis in mainland China

Objective To understand the epidemiology of zygomycosis and the status of diagnosis and treatment in mainland China. Methods Literature from 1976 to 2010 were collected by CNKI and Pubmed and statistically analyzed. Results A total of 206 cases and 428 patients were included in our study. The most common infections of gastrointestinal, pulmonary, sinus and cutaneous sites were often secondary to diabetes, gastrointestinal ulceration, burns, surgery, trauma, or no underlying conditions. Etiology diagnosis depended on direct microscopy, cuhure and pathology, and only 6 cases identified by molecular biology. The antifungal therapy was the main treatment and amphotericin B was the first choice in most cases. The mortality was 29.43% （126/428）. Conclusions Zygomycosis in mailand China had emerged as an increasingly important fungal infection which was in concordance with the world. Gastrointestinal tract was the most popular involvement. Morphological and molecular biological identification are important for accurate and prompt diagnosis. In vitro susceptibility test is helpful for clinical treatment.