恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(草案).ppt

恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则 长海医院呼吸内科 姚小鹏 编者按 侵袭性真菌感染(invasive fungal infections, IFI)日益成为导致恶性血液病及恶性肿瘤患者死亡的重要病因之一。目前已知引起IFI最常见的致病真菌包括曲霉菌菌属和白色念珠菌，然而非白色念珠菌和其他微生物亦呈逐渐增多趋势。为了进一步规范IFI的诊断和治疗，中华内科杂志编辑委员会特约国内有关领域的著名专家，参照国外相关的标准，制定出适合国人的“血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(草案)”，现予以公布，供国内广大同道在临床实践中学习和借鉴。同时希望广大读者在实施过程中对本草案提出修改意见,以供再次修订时参考。 血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则（草案） 诊断标准 定义 确诊侵袭性真菌感染（IFI） 临床诊断IFI 拟诊IFI 治疗原则 预防治疗 经验治疗 临床诊断患者的治疗 确诊后的治疗 Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants: An International Consensus Cooperative Group of the European Organization for Research and Treatment of Cancer and Mycoses Study Group of the National Institute of Allergy and Infectious Diseases During the past several decades, there has been a steady increase in the frequency of opportunistic invasive fungal infections (IFIs) in immunocompromised patients. However, there is substantial controversy concerning optimal diagnostic criteria for these IFIs. Therefore, members of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for IFIs for clinical research. On the basis of a review of literature and an international consensus, a set of research oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed. Three levels of probability are proposed: “proven,” “probable,” and “possible.” The definitions are intended for use in the context of clinical and/or epidemiological research, not for clinical decision making. 讲座内容 真菌感染的基本知识和概念 IFI的治疗药物简介 恶性肿瘤患者IFI的诊断标准 恶性肿瘤患者IFI的治疗原则 一、真菌感染的基本知识和概念 真菌的分类：真菌按形态分单细胞和多细胞两类 单细胞真菌主要为酵母和类酵母菌（如隐球菌、念珠菌），呈圆形或椭圆形 多细胞真菌由菌丝和孢子组成，菌丝分枝交织成团形成菌丝体，并长有各种孢子，这类真菌一般称为霉菌 有些真菌在不同寄生环境和培养条件下出现两种形态，称双相性真菌，即在机体内或含血培养基37℃孵育，呈现酵母型菌落，而在沙保氏培养基上室温孵育，则形成丝状菌落。如荚膜组织胞浆菌