纤维支气管镜检查在肺部真菌感染诊断中的应用

目的 探讨纤维支气管镜检查在肺部真菌感染诊断中的作用。方法 对12例具有真菌感染高危因素的患者进行纤维支气管镜检查，在病变部位进行支气管肺灌洗或肺活检，分别进行真菌培养和组织病理检查。结果 12例患者中有7例诊断为念珠菌肺炎（4例为光滑念珠菌，2例为热带念珠菌，1例为白念珠菌），3例诊断为曲霉肺炎，1例诊断为肺毛霉感染，1例诊断为奴卡菌肺炎。其中6例患者同时合并细菌感染，所有患者根据体外药物敏感试验进行抗真菌和细菌治疗。有5例患者应用了两性霉素B和脂质体两性霉素B，3例应用了伊曲康唑，2例患者联合应用了卡泊芬净。12例患者中治愈5例．死亡5例。放弃治疗2例。结论 纤维支气管镜检查对肺部真菌感染的诊断有一定的价值。

Utility of fibrobronchoscopy in the diagnosis of pulmonary fungal infection

Objective To investigate the role of fibrobronchoscopy in the diagnosis of pulmonary fungal infections. Methods Fibrobronchoscopy was performed in 12 patients with high risk of fungal infection. Lavage specimen from local diseased site was cultured for fungus. Lung tissue biopsy was conducted for pathological study. Results Among the 12 patients, 7 were diagnosed as Candida pneumonia (4 caused by C.glabrata, 2 C.tropicalis, and 1 C.albicans). Aspergillus pneumonia was diagnosed in 3 patients, mucomycosis in 1 patient, and Nocardia pneumonia in 1 patient. Six patients were complicated with bacterial infection. All patients were given antifungal agents or antibiotics according to results of susceptibility testing. Five patients received liposomal amphotericin B or amphotericin B. Three patients were treated with itraconazole. Two patients were treated with combination therapy including caspofingin. Five of the twelve patients survived, five died and the other two withdrew from treatment. Conclusions Fibrobronchoscopy plays an important role in the diagnosis of pulmonary fungal infection.