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無哮喘的變應性支氣管肺曲霉病一例

目的 報道并分析1例變應性支氣管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的臨床特點、診斷及治療方法。方法 結合文獻資料分析我科2019年診治的1例ABPA的病例。結果 該患者診斷明確，治療稍有曲折。ABPA常發生于肺部有基礎疾病者，尤其是支氣管哮喘或囊性纖維化者。臨床表現主要是咳嗽、咳痰、喘息、胸悶；實驗室檢查血清總IgE水平和曲霉特異性IgE水平上升，以及嗜酸性粒細胞數增加；胸部影像學表現為反復的肺部游走性浸潤影和中心性支氣管擴張等。治療包括糖皮質激素和抗真菌治療，對于不能耐受糖皮質激素的患者，抗IgE抗體治療有益。結論 臨床上ABPA容易誤診、誤治，特別是無哮喘病史時，其診斷更加困難。因此早期診斷和正確治療可以減少ABPA造成的肺損傷，改善患者的預后。

眶內霉菌感染一例并文獻復習

【摘要】　目的　報道眶內霉菌感染一例。　方法　2011年3月4日收治1例眶內霉菌感染患者，結合文獻分析其臨床特點及診治方法。　結果　患者為47歲女性，有霉菌性鼻竇炎病史，右眼腫脹、視物模糊。經抗真菌治療，病情穩定出院；后多次復發入院，且出現肝腎功能損害。經抗真菌、保肝、保腎、對癥治療，病情穩定出院。　結論　眶內霉菌感染多系鼻竇炎擴散而來，易復發，療程較長，治療過程中應監測肝腎功能。

Interferon Therapy for Mycosis Fungoides: A Systematic Review

【摘要】　目的　采用系統評價方法，評估干擾素（IFN）治療蕈樣霉菌病（MF）的療效及安全性。　方法　計算機檢索截止2010年5月的Cochrane協作網系統評價方法，納入所有比較IFN與其他方法治療MF的隨機對照試驗及臨床對照試驗進行質量評價，采用RevMan 5.0.24軟件進行Meta分析。　結果　共納入6篇符合標準的已發表文獻，包括142例受試者。Meta分析結果顯示: IFN-α單獨使用對MF的療效優于安慰劑組[OR=69.36，95%CI（3.71～1 296.64）]及地精丹方劑[OR=35.53，95%CI（1.78～710.56）]；而IFN-α與胸腺肽[OR=15.11，95%CI（0.71～322.61）]及IFN-α+阿維A酯[OR=3.10，95%CI（0.79～12.12）]的臨床療效差異無統計學意義；IFN-γ聯合窄譜中波紫外線（NB-UVB）治療與單用NB-UVB的臨床療效差異無統計學意義[OR=15.00，95%CI （0.46～485.32）]。90%的患者出現輕度“流感樣癥狀” 的不良反應，多可緩解及消退。　結論　IFN是目前治療MF的一線用藥，療效確切且大部分患者耐受性較好。【Abstract】　Objective　To evaluate the clinical efficacy and side effects of interferon (IFN) in the treatment of mycosis fungoides (MF) with the method of systematic review. 　Methods　According to the Cochrane reviewer’s handbook, all the clinical controlled trials involving mycosis fungoides being treated with interferon were retrieved. The Cochrane Collaboration’s software RevMan 5.0.24 was used for meta-analysis.　Results　Only six papers including 142 patients met the inclusion criteria. Meta-analyses indicated the results as follows: IFN-α monotherapy was more effective than placebo [OR=69.36,95% CI (3.71-1 296.64)] and a traditional Chinese medicine (Di-jing-dan) [OR=35.53,95% CI (1.78-710.56)], but no significant difference was found between INF-α and thymic peptide [OR=15.11, 95% CI (0.71-322.61)], and between IFN-α monotherapy and IFN-α combined with etretinate therapy [OR=3.10, 95% CI (0.79-12.12)]; and there was no significant difference between the efficacy of IFN-γ combined narrowband ultraviolet B (NB-UVB) therapy and that of single NB-UVB therapy [OR=15.00, 95% CI (0.46-485.32)]; Influenza-like side effects occurred to 90% of all the patients, which were usually slight and easy to release.　Conclusion　Although there are some mild side effects, interferon is safe to treat MF.

Infection Rate of Acquired Immune Deficiency Syndrome Disease Combined with Penicillium Marneffei Laboratory Test Results and Analysis of Susceptibility

目的 探究艾滋病(AIDS)合并馬爾尼菲青霉病(PSM)的感染率，以及常規實驗室檢查結果和5種抗真菌藥物對馬爾尼菲青霉菌(PM)的體外抗菌活性。 方法 2006年1月-2009年11月間確診AIDS患者326例，從其血液、骨髓培養出65株PM，檢測該65例患者的血常規、肝功能和腎功能，并對20株酵母相PM進行體外藥敏進行分析。 結果 AIDS合并PSM的感染率為19.94%；外周血常規：WBClt;4.0×109/L者48例，HBlt;100 g/L者51例，PLTlt;100×109/L者46例。肝功能檢查：ALTgt;40 U/L者49，ASTgt;40 U/L者51例，GGTgt;60 U/L者44例，ALPgt;150 U/L者36例，ALBlt;35 g/L者53例，A/G倒置者50例。腎功能檢查：BUNgt;7.2 mmol/L者9例，Crgt;150 μmol/L者4例。20株酵母相PM對5-氟胞嘧啶(5FC)、兩性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分別為75%、90%、80%、90%、90%。 結論 AIDS合并PSM感染率較高；患者感染后外周血WBC、HB、PLT通常低于正常人，肝功能多表現異常，腎功能的改變較少；對PM的治療以AMB、ITR、VRC為首選。

Clinicopathologic study on fungal necrcotizing retinochoroiditis

Objective To investigate the clinical manifestation and histopathologic changes of the fungal necrotizing retinochoroiditis. Methods Collecting 7 cases of fungal retinochoroiditis with severe immunodepression and loss of visual acuity.Seven removed eyeballs were stained with HE,PAS and silver methenamine,and observed by light microscopy,and in addition,2 of them examined by electron microscopy.Also fungal cultures of blood and affected tissues were performed. Results The chief clinical macnifestation included ciliary injection of conjunctiva,opaque aqueous fluid and vitreous and diffuse hemorrhage and greyt white opacity with retinal detachment in severe cases.Pathologic changes included hemorrhage in the retina,chorioretinal tissue necrosis,hyphae in the blood vessels,affected tissue and vitreous.Fungal culture of blood was positive in three cases.Culture of affected tissues was positive in all cases. Conclusions Eedogenous fungal infection of choroid and retina may be due to the severe immunodepression of the sufferers and usually causes chorioretinal tissue destruction and blind. (Chin J Ocul Fundus Dis, 1999, 15: 235-237)

The Interpretation of Diagnosis and Treatment Guidelines of Aspergillosis from Infectious Diseases Society of America in 2008

聯合檢測半乳甘露聚糖和（1→3）-β-D葡聚糖在診治侵襲性曲霉菌感染中的研究進展

近年隨著廣譜抗生素和免疫抑制劑的使用，侵襲性真菌感染（invasive fungal disease，IFD）的發病率逐年上升。其中侵襲性曲霉病（invasive aspergillosis，IA）在IFD中比例逐年增高。侵襲性曲霉菌感染在血液科和重癥加強治療病房（ICU）最為常見，其次為呼吸內科、感染科和免疫科，IA為免疫功能低下患者致死率高的主要原因，造血干細胞移植（HSCT）患者中IA的發病率為2%~26%，在血液病和造血干細胞移植患者中IA死亡率高達70.0%~90.0%。造成死亡率高的主要原因是在病程早期不能對IA進行可靠診斷，往往使患者延誤治療而死亡。因此，選擇正確、合適的早期診斷方法對疾病的預后具有決定性意義。傳統的診斷方法如影像學、真菌直接鏡檢、培養及組織病理學檢查的敏感性不高，檢出率低，難以用于早期診斷。因此，新的診斷方法對IA的治療至關重要。血清學診斷方法是應用免疫和生化方法檢測血清或其他體液中的真菌細胞壁和胞質成分，分為抗原和抗體檢查兩類。但由于IFD多繼發于嚴重免疫受損患者，往往缺乏可檢測到的抗體，或者抗體的產生變化較大，因此以檢測真菌抗原為主。目前半乳甘露聚糖（GM）和（1→3）-β-D葡聚糖（BG）成為真菌檢查中非常重要的兩個抗原。

狼瘡性腎炎合并肺部多重真菌感染一例

CT、MRI對霉菌性鼻竇炎的診斷價值

目的:探討CT、MRI對霉菌性鼻竇炎的診斷和鑒別診斷價值.方法:回顧性分析32例霉菌性鼻竇炎CT、MRI表現。結果:霉菌性鼻竇炎的CT表現主要為:①90.6%的病變內有高密度鈣化影。大多呈斑點狀,位于竇腔中央,與竇壁無關。②50.0%的竇壁存在骨質破壞,常見于上頜竇內側壁,其特點是伴有竇壁骨質增生。霉菌性鼻竇炎的MRI表現為上頜竇病變中央大部分呈T1、T2低信號。結論:霉菌性鼻竇炎有較特征性的CT、MRI表現,CT對病灶內鈣化顯示較MRI更明確,而且經濟,是首選的影像檢查方法,MRI在評估病變竇腔外受累及與腫瘤鑒別方面優于CT。

Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

ObjectiveTo discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. MethodsWe retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group (open group, n=11) and a video-assisted thoracoscope pneumonectomy group (VATS group, n=28). There were 8 male patients and 3 female patients with age of 29-64 (50.7±9.7) years in the open group. There were 13 male patients and 15 female patients with age of 20-75 (55.4±15.3) years in the VATS group. We compared clinical effectiveness between the two groups. ResultsThe operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time (P=0.001), the loss of intraoperative blood (P=0.005), and the score of pain (P=0.001). There was no statistical difference in lead flow of postoperative chest (P>0.05) and the time of hospitalization (P>0.05). ConclusionVideo-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization．