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全肺切除治療肺毛霉菌病合并肺膿腫一例并文獻復習

目的 探討侵襲性支氣管肺毛霉菌病合并毛霉菌肺膿腫內科治療無效時外科手術的可行性。方法 報告1例2022年在解放軍總醫院第八醫學中心住院的支氣管肺毛霉菌病合并毛霉菌肺膿腫患者內科治療及外科手術過程，并對外科手術在肺毛霉菌病治療中的有關文獻進行復習。結果 患者男性，29歲，某藥廠排污廠房工人，既往患有糖尿病。因咳嗽，咳痰，咯血40余天，高熱5天入院。經支氣管鏡活檢診斷為左主支氣管毛霉菌病，積極內科治療無效時，行左全肺切除術，術后治愈出院。術后病理示支氣管肺毛霉菌病并左下肺毛霉菌肺膿腫。文獻復習顯示外科手術是支氣管肺毛霉菌病治療手段之一，但目前肺毛霉菌病手術治療多限于單純孤立病灶和肺葉切除術，全肺切除術罕見。未檢索到類似本例全肺切除治愈支氣管肺毛霉菌病，毛霉菌肺膿腫的報告。結論 侵襲性支氣管肺毛霉菌病，合并毛霉菌肺膿腫在內科治療無效時，外科手術治療亦應值得考慮。

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)

Detection of Invasive Aspergillosis by Serum Galactomannan Test: A Systematic Review

Objective　To assess the quality of current domestic literature about enzyme-linked immunosorbent assay (ELISA) for invasive aspergillosis diagnosis by detecting Aspergillus galactomannan (GM) antigen, and to analyze the sources of bias and variability, as well as the diagnostic ability of different thresholds. Methods　Both computer-based online search and manual retrieval were employed to identify relevant articles. The statistical information and quality of science were assessed and classified. The data were analyzed using Meta Disc 1.4 software. The best cutoff value for defining a positive test result was selected by summarizing the following statistical indicators as sensitivity, specificity, likelihood ratio (LR) and summary receiver operating characteristic curve (SROC curve), and by calculating the area under the curve (AUC) as well. Results　A total of 20 studies among 2658 literatures were included in accordance with the inclusion criteria, and were divided into different groups based on different cutoff values. Though heterogeneity tests showed no threshold effect, and there were other reasons of heterogeneity. So the data were analyzed by random effects model. The results showed that, compared with other groups, the one with cutoff value set at 0.7 (AUC=0.9456, Q= 0.884 6) showed the best accuracy in diagnosing. Conclusion　ELISA detection of Aspergillus GM antigen with cutoff value set at 0.7 has important significance in the early diagnosis of invasive aspergillosis, and it can be conducive to reduce mortality in patients at high risk for Aspergillus infection.

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.

侵襲性肺曲霉菌感染診治進展

隨著社會老齡化, 抗腫瘤藥物、免疫抑制劑和器官移植等治療的廣泛開展, 在危重患者中廣譜抗生素藥物的長期應用, 與之伴隨的是真菌感染發生的逐年增多, 其中侵襲性曲霉菌感染因其感染隱匿, 難以診治和高死亡率等特點被臨床醫生所重視。按我國醫院感染監控網分析, 醫院真菌感染率從1993 ～1996 年的13. 9% 上升至1998 ～1999 年的17. 1% 、1999 ～2000 年的24. 4% 。侵襲曲霉菌病特別是肺部曲霉菌感染多發生在有嚴重基礎疾病的患者,預后差, 病死率達50% ～100% [ 1 ] 。本文回顧相關研究文獻中關于侵襲性肺曲霉菌診治進展, 高危人群, 目前診斷檢測技術的臨床價值, 抗曲霉菌藥物特點和治療現狀。

長期服用糖皮質激素及免疫抑制劑致肺曲霉菌感染一例

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。

肺曲霉菌病的外科治療

目的探討肺曲霉菌病的臨床特點與外科治療原則。方法回顧分析32例肺曲霉菌病患者的臨床資料和手術治療結果，手術施行采用標準后外側切口肺葉切除術6例，楔形切除術3例，胸腔鏡或胸腔鏡輔助改良后外側微創小切口楔形切除術15例，肺葉切除術6例，肺段切除術2例。結果21例無肺原發疾病，11例有肺原發疾病。痰菌檢查陽性率為13．3％（2／15），術前診斷符合率為28．1％（9／32）；術后并發癥發生率為15．6％（5／32），其中切口皮下積液、肺膨脹不良各2例，氣胸1例；隨訪32例，隨訪10～160個月，無咯血或血痰、肺曲霉菌病復發或播散。結論肺曲霉菌病多數無肺原發疾病和癥狀，無論有否癥狀均應手術治療，而微創外科手術治療并發癥少且較輕，是首選的治療方法。

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。

Role of aspergillus infection in bronchiectasis and its diagnosis and treatment

Bronchiectasis is a heterogeneous disease characterized by abnormal expansion of the bronchi, manifested by cough, sputum, and recurring lung infections. As one of the common fungi of lung infection, aspergillus can not only appear as the outcome of the disease in bronchiectasis, but also as an inducement to participate in the disease progression, and ultimately complicate the course of bronchiectasis. This article describes the susceptibility factors and pathogenic mechanisms of aspergillus in bronchiectasis, and further introduces the diagnosis and treatment status of bronchiectasis combined with aspergillus infection, aiming to clarify the effect of aspergillus infection on bronchiectasis and provide new thinking directions for its clinical diagnosis and treatment.