侵袭性肺曲霉病诊治需要注意的几个问题
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摘要
近20年来侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)作为器官移植受者、骨髓干细胞移植受者以及合并有慢性肺部疾病患者主要的并发症在临床上明显增多,也是患者致残和死亡的原因之一。该文就IPA诊治过程中需要注意的几个问题,如IPA的诊断标准、肺曲霉病的分类、半乳甘露聚糖抗原(galactomannan,GM)试验和1,3-β-D葡聚糖(G试验)检测对IPA诊断的价值、IPA的临床处理原则以及IPA的抗真菌药物治疗等问题作一讨论。
Invasive pulmonary aspergillosis(IPA) represents a major complication in recipients of hematopoietic stem cell transplantation and solid-organ transplantation.The incidence of IPA in transplant recipients and in patients who have underlying lung diseases has increased over the past 20 years,and these infections continue to be associated with high morbidity and mortality.This article reviews some problems in terms of IPA diagnosis standard,classification of pulmonary aspergillosis,GM test and G test diagnostic value and clinical management of IPA.
Invasive pulmonary aspergillosis(IPA) represents a major complication in recipients of hematopoietic stem cell transplantation and solid-organ transplantation.The incidence of IPA in transplant recipients and in patients who have underlying lung diseases has increased over the past 20 years,and these infections continue to be associated with high morbidity and mortality.This article reviews some problems in terms of IPA diagnosis standard,classification of pulmonary aspergillosis,GM test and G test diagnostic value and clinical management of IPA.
引文
1中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J].中华内科杂志,2006,45(8):697-700.
2中华医学会呼吸病学分会感染学组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
3中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709.
4周新.国内外侵袭性真菌病诊治指南的解读与比较[J].中华结核和呼吸杂志,2009,32(12):962-964,896.
5 Walsh TJ,Anaissie EJ,Denning DW,et al.Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J].Clin Infect Dis,2008,46(3):327-360..
6 De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Disease Mycoses Study Group(EORTC/MSG)Consensus Group[J].Clin Infect Dis,2008,46(12):1813-1821.
7 Patterson TF,Thomson GR 3rd,Denning DW,et al.Practice guidelines for the diagnosis and management of aspergillosis:2016 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4):e1-e60.
8 Denning DW,Cadranel J,Beigelman-Aubry C,et al.Chronic pulmonary aspeigillosis:rationale and clinical guidelines for diagnosis and management[J].Eur Respir J,2016,47(1):45-68.
2中华医学会呼吸病学分会感染学组,中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
3中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709.
4周新.国内外侵袭性真菌病诊治指南的解读与比较[J].中华结核和呼吸杂志,2009,32(12):962-964,896.
5 Walsh TJ,Anaissie EJ,Denning DW,et al.Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J].Clin Infect Dis,2008,46(3):327-360..
6 De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Disease Mycoses Study Group(EORTC/MSG)Consensus Group[J].Clin Infect Dis,2008,46(12):1813-1821.
7 Patterson TF,Thomson GR 3rd,Denning DW,et al.Practice guidelines for the diagnosis and management of aspergillosis:2016 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4):e1-e60.
8 Denning DW,Cadranel J,Beigelman-Aubry C,et al.Chronic pulmonary aspeigillosis:rationale and clinical guidelines for diagnosis and management[J].Eur Respir J,2016,47(1):45-68.