目的 探讨念珠菌血症患者临床特征以及影响预后的危险因素.方法 回顾性分析2010年1月-2016年1月四川大学华西医院经血培养确诊为念珠菌血症的临床资料,调查其临床特征(包括科室分布、基础疾病、病原菌分布、抗真菌治疗以及预后),应用STATA软件进行预后多因素生存分析.结果 6年间,共检出念珠菌血症患者162例,其中,男性132例(81％),死亡49例(30.2％).病原菌分布包括白念珠菌(38％),热带念珠菌(24.7％),光滑念珠菌(16％),近平滑念球菌(12.3％),克柔念珠菌(2.5％),高里念珠菌(2.5％),新隐球菌(2.5％)和酵母菌(0.6％).多因素生存分析显示机械通气、气管切开、入住心胸外科、AECOPD、预防性给予抗真菌药的危险比(HR)分布为7.24,3.34,27.54,8.51和0.049.结论 机械通气、入住心胸外科、AECOPD、气管切开是念珠菌血症患者死亡的独立危险因素,预防性抗真菌药物治疗可改善生存.监测这些因素可能对念珠菌血症患者生存率的改善具有重大临床意义.%Objective To explore clinic features and evaluate the prognosis factors for death of candidemia for early identification and prevention of the disease.Methods A retropective study based on clinic data were carried out on candidemia isolates who were collected from hospitalized patients in west china hospital of Sichuan University from January 2010 to January 2016.Underlying diseases,species distribution,antifungal therapy and prognosis were analyzed.Multivariate survival analysis was performed with the use of STATA software.Results A total of 162 cases with candidemia were identified.132 (81％) were male.49(30.2％) were died.Of these patients,38.3％ had candidemia due to C.albicans,followed by C.tropicalis (24.7％),C.glabrata (16.0％),C.parapsilosis (12.3％),C.krusei (2.5％),C.ghauri (2.5％),C.neoformans(2.5％),Yeast(0.6％).Multivariate survival analysis showed that the hazard ratio (HR) of mechanical ventilation was 7.24,tracheotomy was 3.34,cardiothoracic surgery was 27.54,AECOPD was 8.51,and prophylaxis antifungal drugs treatment was 0.049.Conclusion Mechanical ventilation,cardiothoracic surgery,AECOPD and tracheotomy were the independent risk factors for patients' death with candidemia.Prophylaxis antifungal drugs treatment influenced the survival.Detection of these factors may have significant implications for the improvement of candidemia survival.
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