侵袭性真菌感的染的经验性和抢先治疗.pdf

·专家论坛· 侵袭性真菌感染的经验性和抢先治疗 刘正印 * （中国医学科学院北京协和医院感染内科 北京 100730） 摘 要 侵袭性真菌感染（invasive fungal infection, IFI）更趋常见，其原因除广谱抗生素的应用以及肿瘤放疗和化疗、 造血干细胞移植、器官移植和免疫功能缺陷患者增多等外，最主要的是新的诊断真菌感染的临床实验室技术、尤其是半 乳甘露聚糖试验和 (1,3)-β-D- 葡聚糖试验的应用逐渐普及，为临床诊断 IFI 提供了坚实的基础。此外，IFI 的影像学特征 也成为诊断 IFI 的一个重要条件。与经验性抗真菌治疗相比，这些实验室和影像学检查的阳性结果可提高诊断的可靠性， 由此为真菌感染治疗提供更多的依据，同时减少抗真菌药物的滥用。 关键词 侵袭性真菌感染 经验性治疗 抢先治疗 中图分类号 ：R519; R44 文献标识码 ：A 文章编号 ：1006-1533(2014)09-0008-03 Empirical versus preemptive antifungal therapy for invasive fungal infection Liu Zhengyin* (Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China) Abstract Due to the use of broad-spectrum antibiotics and the increasing number of the immune-incompetent patients who received tumor radiotherapy and chemotherapy, hematopoietic stem cell transplantation, organ transplantation as well as immunosuppressive therapy, the incidence of invasive fungal infection (IFI) has been gradually increased. Another more important cause was the improvement of the laboratory and imaging diagnosis technology, especially (1,3)-β-D-glucan test and galactomannan test, which provide solid basis for clinical diagnosis of IFI so as to increase the diagnostic rate. Compared with empirical anti-fungal therapy, these positive results from the laboratory assay and imaging examination can increase the reliability of the diagnosis of IFI and provide more evidence for the treatment of IFI, and meanwhile reduce the abuse of antifungal agents. Key wordS invasive fungal infection; empirica