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经纤维支气管镜诊断曲霉感染100例分析

目的探讨纤维支气管镜检查在肺曲霉感染诊断中的作用。 方法回顾性分析2012年至2014年我院100例曲霉感染患者的临床资料及纤维支气管镜(简称纤支镜)检查结果。 结果100例曲霉感染患者中, 男65例, 女35例, 年龄12~85岁, 30岁以下患者15例。62例合并基础疾病, 包括20例结核, 23例肿瘤, 6例慢性阻塞性肺疾病。36例患者经纤支镜病理检查确诊, 其中4例经纤支镜肺活检确诊, 无并发症发生; 64例患者纤支镜灌洗液或痰液曲霉培养阳性, 属于临床诊断。 结论纤支镜病理检查及灌洗液培养是诊断肺曲霉感染的有效手段, 若临床情况允许, 应尽早进行纤支镜检查明确诊断。

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

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.

非免疫缺陷患者确诊为纵隔黄曲霉脓肿一例报道并文献复习

目的 总结分析纵隔曲霉病的临床特征，以提高临床医生对纵隔曲霉病的认识。方法 回顾性分析1例纵隔黄曲霉脓肿患者的临床资料、实验室检查、影像学检查、治疗方案及预后，并复习国内外相关文献。结果 患者男，68岁，其胸部CT示纵隔肿块，伴气管、右主支气管复杂狭窄，纤维支气管镜及经超声支气管镜针吸活检（endobronchial ultrasound-guided transbronchial needle aspiration，EBUS-TBNA）及宏基因组二代测序（metagenomic next-generation sequencing，mNGS）诊断为纵隔黄曲霉脓肿。予伏立康唑及激素治疗后病情好转，4个月后随访患者病情稳定。以“纵隔曲霉病、纵隔脓肿”与“非免疫缺陷者”为关键词检索中国知网医学数据库和维普网数据库，国内尚无文献报道。使用“mediastinal aspergillosis”、“aspergillus mediastinitis”、“mediastinal aspergilloma”检索PubMed数据库中的英文文献，共检索到文献17篇，均为个案报道。结论 非免疫缺陷患者出现纵隔肿物时，需警惕曲霉感染的可能，早期及时的诊断及治疗尤为重要。EBUS-TBNA联合mNGS可作为纵隔曲霉病的诊断方法之一。伏立康唑联合小剂量激素（0.5 mg/kg）治疗方案，可能为纵隔曲霉病提供新的治疗思路。

Mechanisms of Aspergillus Fumigatus Invasion

随着免疫抑制人群的增多、检测技术的发展, 深部真菌感染日益受到人们的关注。真菌中的曲霉属成了这些免疫功能低下患者致病性感染的重要原因, 而烟曲霉在侵袭性曲霉病例中最常见。侵袭力是烟曲霉菌极为重要的致病原因;病原菌侵入上皮、内皮细胞等组织细胞后才导致了可怕的侵袭性感染。从上世纪90 年代来, 对于侵袭的研究已逐步深入, 为探讨复杂的致病机制打下了基础。侵袭性烟曲霉病一般的致病过程认为是烟曲霉孢子被宿主吸入下呼吸道, 侵入呼吸道上皮细胞后发育成菌丝, 菌丝进一步生长, 可侵入血管、进入血液, 造成全身播散[ 1] 。因此曲霉与宿主细胞( 上皮细胞、内皮细胞等) 的相互作用成了致病过程的重要环节。目前对病原体与宿主细胞作用的研究取得了一些进展, 对阐明致病机制、研究治疗靶点等有重要意义。

Preparation of 99mTc Labeled Anti-Aspergillus Monoclonal Antibody and Biodistribution in Normal Mice

Objective To explore the method of radiolabeling anti-Aspergillus monoclonal antibody (WF-AF-1)with 99mTc,and evaluate the in vitro and in vivo characteristics of 99mTc labeled WF-AF-1 (99mTc-WF-AF-1). Methods 99mTc-WF-AF-1 was prepared with indirect-labeling method.The labeled product was identified using thin layer chromatography.Suspensions of Aspergillus fumigatus,Staphylococcus aureus and Candida albicans were incubated with 99mTc-WF-AF-1 to evaluate the specificity of the labeled antibody.Mice were injected with 3.7MBq of labeled product.The biodistribution was measured at 40min,2h,4h and 7h after injection. Results The labeling efficiency of 99mTc-WF-AF-1 was over 95%,and the labeled product was stable in serum and phosphate buffer solution.In vitro binding of 99mTc-WF-AF-1 revealed that the labeled Mab-WF-AF-1 preferentially binds to Aspergillus fumigatus. Biodistrbution data showed that the labeled antibody was deposited mainly in liver,kidneys and spleen.The radioactivity uptake in blood at 40min and 7h was (2.51±0.23)%ID/g and (0.53±0.13)%ID/g,respectively. Conclusions The labeling efficiency and stability of 99mTc-WF-AF-1 are high.The labeled antibody is excreted mainly through the liver and kidneys with fast clearance in blood in normal mice.

痰培养联合曲霉血清学GM试验对诊断侵袭性曲霉感染的临床价值研究

目的评价痰培养联合曲霉血清学半乳甘露聚糖(GM)试验对侵袭性曲霉感染的临床诊断价值。 方法对济宁医学院附属医院2012年7月至2013年7月间疑似曲霉感染的216例住院患者进行痰培养和血清ELISA检测。以临床诊断为标准, 评估痰培养和GM试验及联合检测的敏感性、特异性、阳性预测值和阴性预测值, 采用χ2检验进行比较。应用受试者工作特征曲线(ROC曲线)比较不同检测的疾病识别能力。 结果痰培养的敏感性和特异性为60.4%和69.9%, GM试验为94.3%和94.5%, 二者联合检测可将诊断的敏感性和特异性分别提高至98.1%和99.4%。联合检测的ROC曲线下面积(AUC)为0.960, 95%可信区间为0.929~0.992。 结论痰真菌培养联合血清GM抗原检测能大幅提高曲霉感染病例的临床诊断效率。

Misdiagnostic Causes of Pulmonary Aspergillosis

【摘要】　目的　探讨并分析导致肺曲霉病患者误诊的原因，为早期诊断并及时正确治疗提供科学的依据。　方法　回顾性分析2010年1-4月间确诊为肺曲霉病的3例患者在诊治过程中被误诊的原因。　结果　3例患者均缺乏明显的特异性临床表现和影像学表现，最后确诊均依据病理学活检证实。　结论　肺部的曲霉菌感染缺乏特异性的临床和影像学表现，及早行纤维支气管镜检查或肺组织活检可提高早期诊断率。【Abstract】　Objective　To analyze the misdiagnostic causes of pulmonary aspergillosis.　Methods　The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed.　Result　No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy.　Conclusion　Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.

变态反应性支气管肺曲霉病一例及文献复习

目的　报道并分析1例变态反应性支气管肺曲霉病（ABPA）的诊断和治疗。 方法　采用病例报告的方式对2010年10月至2011年9月1例ABPA病例进行分析。 结果　患者诊断ABPA明确，治疗效果明显。 结论　ABPA临床早期诊断困难，需要尽早进行痰培养、血清总IgE等相关检查以明确诊断，激素和抗真菌药物是目前有效的治疗方法，早期诊断、早期治疗能改善患者预后。

侵袭性肺曲霉菌感染诊治进展

随着社会老龄化, 抗肿瘤药物、免疫抑制剂和器官移植等治疗的广泛开展, 在危重患者中广谱抗生素药物的长期应用, 与之伴随的是真菌感染发生的逐年增多, 其中侵袭性曲霉菌感染因其感染隐匿, 难以诊治和高死亡率等特点被临床医生所重视。按我国医院感染监控网分析, 医院真菌感染率从1993 ～1996 年的13. 9% 上升至1998 ～1999 年的17. 1% 、1999 ～2000 年的24. 4% 。侵袭曲霉菌病特别是肺部曲霉菌感染多发生在有严重基础疾病的患者,预后差, 病死率达50% ～100% [ 1 ] 。本文回顾相关研究文献中关于侵袭性肺曲霉菌诊治进展, 高危人群, 目前诊断检测技术的临床价值, 抗曲霉菌药物特点和治疗现状。