51例马尔尼菲青霉菌病临床分析
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摘要
目的探讨广西壮族自治区马尔尼菲青霉菌病(Penicilliosis Marneffei PSM)的流行病学、临床特征、治疗方案。
方法回顾性分析广西医科大学第一附属医院2004年1月至2008年12月收治的51例PSM患者的临床资料。
结果51例患者中合并艾滋病(AIDS)35例,非AIDS16例。临床上以发热(96.1%)、贫血(82.4%)、消瘦(76.5%)、皮损(68.6%)、咳嗽(62.7%)、淋巴结肿大(60.8%)为主要表现;合并AIDS者,全身中毒症状严重,皮疹呈播散性、有坏死。外周血CD4+T淋巴细胞的平均值为15.25个/ul,大多数(82.5%)患者CD4+<500个/ul,96.3%的AIDS患者CD4+<50个/ul。合并AIDS患者谷丙转氨酶、谷草转氨酶异常率较非AIDS患者高(P<0.05)。临床标本中皮肤活检阳性率最高(80%)、其次是血培养(78.8%)、骨髓培养(75%),皮损/分泌物培养(66.7%)。两性霉素B疗效优于氟康唑(P<0.05),合并AIDS者与非AIDS者治愈好转率无统计学差异(P>0.05)。
结论广西壮族自治区的PSM好发于AIDS患者。临床表现复杂多样,以发热、贫血、消瘦、皮损、咳嗽、淋巴结肿大、肝脾肿大为主,脐凹样皮疹有特征性。皮肤活检、血培养、骨髓培养、皮损/分泌物培养阳性率较高。治疗上两性霉素B效果优于氟康唑。PSM合并AIDS与非AIDS临床表现、实验室检查有所不同。
Objective To explore the epidemiological and clinical features、therapeutic regimens of Penicilliosis Marneffei(PSM)found in Guangxi province.
Methods Through reviewing clinical data of 51 cases with PSM admitted to the first affiliated hospital of Guangxi Medical University from January 2004 to December 2008.
Results Among the 51 cases,35 were associated with AIDS, 16 were not associated with AIDS. The most common clinical presentations were fever(96.1%),anemia(82.4%), weightloss(76.5%),skinlesion(68.6%),cough (62.7%),and lymphadenectasis(60.8%).The patients complicated with AIDS presented severe systemic toxic symptoms and disseminated、necrotic skin rashes. Mean CD4+ lymphocyte counts in peripheral blood was 15.25 cells/ul. Most patients had CD4+ lymphocyte counts less than 500 cells/ul(82.5%),and those complicated with AIDS(96.3%) had CD4+ lymphocyte counts less than 50 cells/ul.The abnormal rate of alanine aminotransferase and aspartate aminotransferase of patients complicated with AIDS was higher than that of non-AIDS patients(P<0.05).In different clinical specimens,the highest positive rate was skin biopsy(80%), followed by blood culture(78.8%)、bone marrow culture(75%)、tissue / secretion culture(66.7%).The efficacy of amphotericin B was better than that of fluconazole(P<0.05).There was no significant difference in cure and improvement rate between patients with and without AIDS(P>0.05). Conclusions Most PSM cases in Guangxi were found in AIDS patient。
Common manifestations of PSM are relatively non-specific, the most common clinical presentations were fever,anemia,weight loss, skin lesion, cough, lymphadenectasis, hepatomegaly and splenomegaly. Specific skin rashes were helpful to dagnose PSM.PM was isolated most frequently from skin biopsies,blo- od cultures, bone marrow and tissue / secretion cultures. The efficacy of amphotericin B was better than that of fluconazole.There were some differences between the patients complicated with AIDS and those non-AIDS in the clinical features, laboratory examinations.
方法回顾性分析广西医科大学第一附属医院2004年1月至2008年12月收治的51例PSM患者的临床资料。
结果51例患者中合并艾滋病(AIDS)35例,非AIDS16例。临床上以发热(96.1%)、贫血(82.4%)、消瘦(76.5%)、皮损(68.6%)、咳嗽(62.7%)、淋巴结肿大(60.8%)为主要表现;合并AIDS者,全身中毒症状严重,皮疹呈播散性、有坏死。外周血CD4+T淋巴细胞的平均值为15.25个/ul,大多数(82.5%)患者CD4+<500个/ul,96.3%的AIDS患者CD4+<50个/ul。合并AIDS患者谷丙转氨酶、谷草转氨酶异常率较非AIDS患者高(P<0.05)。临床标本中皮肤活检阳性率最高(80%)、其次是血培养(78.8%)、骨髓培养(75%),皮损/分泌物培养(66.7%)。两性霉素B疗效优于氟康唑(P<0.05),合并AIDS者与非AIDS者治愈好转率无统计学差异(P>0.05)。
结论广西壮族自治区的PSM好发于AIDS患者。临床表现复杂多样,以发热、贫血、消瘦、皮损、咳嗽、淋巴结肿大、肝脾肿大为主,脐凹样皮疹有特征性。皮肤活检、血培养、骨髓培养、皮损/分泌物培养阳性率较高。治疗上两性霉素B效果优于氟康唑。PSM合并AIDS与非AIDS临床表现、实验室检查有所不同。
Objective To explore the epidemiological and clinical features、therapeutic regimens of Penicilliosis Marneffei(PSM)found in Guangxi province.
Methods Through reviewing clinical data of 51 cases with PSM admitted to the first affiliated hospital of Guangxi Medical University from January 2004 to December 2008.
Results Among the 51 cases,35 were associated with AIDS, 16 were not associated with AIDS. The most common clinical presentations were fever(96.1%),anemia(82.4%), weightloss(76.5%),skinlesion(68.6%),cough (62.7%),and lymphadenectasis(60.8%).The patients complicated with AIDS presented severe systemic toxic symptoms and disseminated、necrotic skin rashes. Mean CD4+ lymphocyte counts in peripheral blood was 15.25 cells/ul. Most patients had CD4+ lymphocyte counts less than 500 cells/ul(82.5%),and those complicated with AIDS(96.3%) had CD4+ lymphocyte counts less than 50 cells/ul.The abnormal rate of alanine aminotransferase and aspartate aminotransferase of patients complicated with AIDS was higher than that of non-AIDS patients(P<0.05).In different clinical specimens,the highest positive rate was skin biopsy(80%), followed by blood culture(78.8%)、bone marrow culture(75%)、tissue / secretion culture(66.7%).The efficacy of amphotericin B was better than that of fluconazole(P<0.05).There was no significant difference in cure and improvement rate between patients with and without AIDS(P>0.05). Conclusions Most PSM cases in Guangxi were found in AIDS patient。
Common manifestations of PSM are relatively non-specific, the most common clinical presentations were fever,anemia,weight loss, skin lesion, cough, lymphadenectasis, hepatomegaly and splenomegaly. Specific skin rashes were helpful to dagnose PSM.PM was isolated most frequently from skin biopsies,blo- od cultures, bone marrow and tissue / secretion cultures. The efficacy of amphotericin B was better than that of fluconazole.There were some differences between the patients complicated with AIDS and those non-AIDS in the clinical features, laboratory examinations.
引文
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