本文選題：腎病綜合征 + 侵襲性真菌病��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過分析激素或(及)免疫抑制劑治療的腎病綜合征合(NS)患者伴發(fā)侵襲性真菌病(IFD)的相關(guān)因素以及療效,為更好的防治腎病綜合征病人伴發(fā)侵襲性真菌病提供依據(jù)。方法:選取2012年1月1日至2017年1月1日于重慶醫(yī)科大學(xué)附屬第二醫(yī)院腎內(nèi)科住院的接受激素或(及)免疫抑制劑治療的NS伴發(fā)IFD的患者21例(IFD組),并選擇同期接受激素或(及)免疫抑制劑治療的腎病綜合征未伴發(fā)IFD的患者42例(No-IFD組)。分別收集兩組患者的一般情況、臨床資料、發(fā)生IFD前的藥物治療情況進行相關(guān)因素分析。并對IFD組進行亞組分析,進一步比較亞組中患者激素和免疫抑制的治療時間與IFD發(fā)生的關(guān)系,以及亞組中患者的臨床表現(xiàn)、診斷方法、治療方案及療效,總結(jié)腎病綜合征伴發(fā)侵襲性真菌病的診治經(jīng)驗。結(jié)果:(1)腎病綜合征患者接受激素或(及)免疫抑制劑治療發(fā)生IFD的發(fā)病率為10.3%。(2)一般資料中:IFD組平均年齡較No-IFD組大(p0.05),男女比例無差異。IFD組既往肺部影像學(xué)檢查提示肺間質(zhì)纖維化的比例較No-IFD組更高(p0.05),而既往肺部疾病病史兩組差異無顯著性。(3)臨床資料對比顯示:相較于No-IFD組,IFD組患者24小時尿蛋白定量水平、肌酐水平,細菌培養(yǎng)陽性率明顯升高,IgM水平、淋巴細胞比例及淋巴細胞計數(shù)均明顯降低,差異具有統(tǒng)計學(xué)意義(P0.05)。而兩組患者的血漿白蛋白、IgG、IgA、C3水平則差異不大。(4)IFD發(fā)生前的NS治療情況:IFD組加用免疫制劑治療的比例更高,差異顯著(P0.01)。免疫抑制的使用種類對IFD的發(fā)生沒有顯著的影響(P0.05)。IFD組使用4天以上廣譜抗生素、以及聯(lián)用兩種或兩種以上抗生素治療的比例更高(P0.05)。而激素沖擊治療的比例兩組無明顯差異(P0.05)。(5)亞組分析結(jié)果顯示:在強的松1mg/kg·d-1的劑量治療下,1月后IFD發(fā)生率增加,并于1-2月時達最高峰。使用免疫抑制劑4周內(nèi)易發(fā)生IFD,且使用不同的免疫抑制劑,發(fā)生IFD的時間不同。發(fā)熱為IFD的早期癥狀,呼吸道IFD的發(fā)生率最高。1-3-β-D葡聚糖檢測NS合并IFD的敏感性為95.24%。伊曲康唑與伏立康唑?qū)τ贗FD治療的有效率存在差異,但差異無統(tǒng)計學(xué)意義。結(jié)論:(1)接受激素或(及)免疫抑制劑治療的NS患者伴發(fā)IFD與年齡、影像學(xué)肺間質(zhì)改變、24小時尿蛋白定量水平、血肌酐水平、IgM、淋巴細胞比例及計數(shù)、細菌培養(yǎng)陽性、使用及聯(lián)用廣譜抗生素、加用免疫抑制劑有關(guān)。(2)激素使用1月后、免疫抑制劑使用4周內(nèi)為IFD的易感時期。(3)1-3-β-D葡聚糖檢測NS合并IFD的敏感性高,可用于早期診斷IFD。(4)伊曲康唑與伏立康唑治療IFD的有效率差異無顯著性,早期治療是改善IFD預(yù)后的關(guān)鍵。
[Abstract]:Objective: to provide evidence for better prevention and treatment of invasive mycosis in patients with nephrotic syndrome (NS) treated by hormone or / or immunosuppressive agents. Methods: from January 1, 2012 to January 1, 2017, 21 patients with NS associated with IFD who received hormone or / and immunosuppressive therapy in Department of Nephrology, second affiliated Hospital, Chongqing Medical University, were selected. 42 patients with nephrotic syndrome without IFD who received hormone or / and immunosuppressive therapy were treated with No-IFD. The general condition, clinical data and drug treatment before IFD were collected and analyzed. The relationship between the time of hormone and immunosuppressive therapy and the occurrence of IFD, the clinical manifestation, diagnostic method, treatment plan and curative effect of the patients in the IFD group were compared. To summarize the experience of diagnosis and treatment of nephrotic syndrome with invasive mycosis. Results the incidence of IFD in patients with nephrotic syndrome treated with hormone or / and immunosuppressant was 10.3%.) the average age of IFD group was larger than that of No-IFD group (P 0.05). There was no difference between male and female. The ratio of pulmonary interstitial fibrosis was higher than that of No-IFD group, but there was no significant difference between the two groups in the history of pulmonary disease. The level of creatinine, the positive rate of bacteria culture significantly increased the level of IgM, the proportion of lymphocytes and the lymphocyte count decreased obviously, the difference was statistically significant (P 0.05). However, there was no significant difference between the two groups in the level of IgGG, IgA, C 3. The proportion of NS treatment before the occurrence of IFD was higher in the control group than that in the control group, and the difference was significant (P 0.01). The type of immunosuppressive therapy had no significant effect on the occurrence of IFD. The proportion of two or more antibiotics was higher in the P0.05. IFD group than that in the P0.05. IFD group, which was treated with broad-spectrum antibiotics for more than 4 days. However, there was no significant difference in the proportion of hormone shock therapy between the two groups. The results of subgroup analysis showed that the incidence of IFD increased after 1 month of prednisone 1mg/kg d-1 treatment, and reached its peak in January and February. Immunosuppressive agents were easy to occur in 4 weeks, and different immunosuppressants were used for different time of occurrence of IFD. Fever was the early symptom of IFD. The incidence of respiratory IFD was the highest. The sensitivity of NS with IFD was 95.24. There was a difference between itraconazole and voleconazole in the effective rate of IFD, but the difference was not statistically significant. Conclusion IFD and age, 24 hour urinary protein quantitative level, serum creatinine level, lymphocyte percentage and count, positive bacterial culture were found in patients with NS treated with hormone or / or immunosuppressant. After using and combining with broad-spectrum antibiotics and adding immunosuppressant related hormone, the sensitivity of NS combined with IFD was high when immunosuppressant was used for 4 weeks as the susceptible period of IFD. There was no significant difference in the effective rate between itraconazole and voleconazole in the treatment of IFD. Early treatment was the key to improve the prognosis of IFD.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692;R519

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相關(guān)期刊論文 前10條

1 孔德勝;孔偉;靳永強;王香花;;溶血和黃疸對(1,3)-β-D-葡聚糖檢測的影響[J];世界最新醫(yī)學(xué)信息文摘;2015年09期

2 劉艷;張碧麗;王文紅;劉U，

本文編號：1798863