中国大陆地区曲霉病流行现状分析

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。

Epidemiology of aspergillosis in mainland China

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.