基础医学与临床 ›› 2017, Vol. 37 ›› Issue (10): 1449-1451.

• 临床研究 • 上一篇    下一篇

霉菌性食管炎临床分析

费贵军1,侍效春1,杨爱明2   

  1. 1. 中国医学科学院 北京协和医学院 北京协和医院
    2. 北京协和医院消化内科
  • 收稿日期:2017-03-16 修回日期:2017-05-24 出版日期:2017-10-05 发布日期:2017-09-25
  • 通讯作者: 费贵军 E-mail:feigj89@aliyun.com

Clinical analysis of fungal esophagitis

  • Received:2017-03-16 Revised:2017-05-24 Online:2017-10-05 Published:2017-09-25

摘要: 目的 探讨霉菌性食管炎的临床表现和诊断,提高对霉菌性食管炎的认识。 方法 回顾性分析2013年1月至2015年12月北京协和医院胃镜检查诊断的38例霉菌性食管炎患者的临床资料。 结果 患者平均年龄(54.0±1.5)岁;男性26例,女性12例。29例(76.3%)患者有至少一种危险因素。7例合并口腔念珠菌病。仅10例患者表现出霉菌性食管炎的常见症状。按Kodsi等的内镜下分级,Ⅰ级6例;Ⅱ级29例;Ⅲ级1例;Ⅳ级2例。多数患者接受了系统性抗真菌治疗,但有1例患者未经治疗复查胃镜自愈。结论 霉菌性食管炎临床症状不典型,诊断需要依据胃镜检查并组织病理和病原学检查;推荐给予全身性抗真菌治疗,首选氟康唑。然而,对于免疫功能正常、无症状和内镜下病变轻微的患者,是否需要系统性抗真菌治疗还有待进一步研究。

关键词: 霉菌, 食管炎, 诊断

Abstract: Objective To sum up the experience in diagnosis of fungal esophagitis. Methods An analysis was performed on clinical data of 38 cases of fungal esophagitis diagnosed through gastroscopy in Peking Union Medical College Hospital from 2013 to 2015. Results Of 38 cases, 26 were males and 12 were females. The mean age was (54.0±1.5) years old. 76.3% had at least one risk factor. 7 patients had oral candidiasis and 10 patients had typical symptom of fungal esophagitis. Endoscopic severity was classified according to Kodsi’s grade: gradeⅠ 6 cases, grade Ⅱ 29 cases, grade Ⅲ 1 case,grade Ⅳ 2 cases. Most patients were treated with systemic antifungal therapy. However, one patient’s fungal esophagitis resolved without any treatment. Conclusions Endoscopy with biopsy is a valuable definitive diagnostic method for fungal esophagitis, especially for asymptomatic patients or those without oral candidiasis. Systemic antifungal treatment is recommended with fluconazole as the first choice. Further studies are needed to determine if systemic antifungal therapy is necessary for asymptomatic and immunocompetent patients with mild fungal esophagitis.

Key words: fungal, esophagitis, diagnosis

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