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1、Copyright belong to ECCMID Conference Any business purposes is forbidden Copyright belong to ECCMID Conference Any business purposes is forbidden European Congress of European Congress of Clinical Microbiology Clinical Microbiology and Infectious and Infectious DiseasesDiseases 霉菌感染领域的高影响因子文献霉菌感染领域的
2、高影响因子文献TOP 10TOP 10 2015 252015 25th th ECCMID Demark Copenhagen ECCMID Demark Copenhagen TOP Ten Paper in Mycology Diagnostics and Susceptibility testing Paper1Paper1 比较血清比较血清GMGM与与GM PCRGM PCR的诊断价值的诊断价值 Copyright belong to ECCMID Conference Any business purposes is forbidden Copyright belong to EC
3、CMID Conference Any business purposes is forbidden European Congress of European Congress of Clinical Microbiology Clinical Microbiology and Infectious and Infectious DiseasesDiseases Serum Serum GalactomannanGalactomannan Versus a Versus a Combination of Combination of GalactomannanGalactomannan an
4、d Polymerase and Polymerase Chain Reaction Based Chain Reaction Based AspergillusAspergillus DNA DNA Detection Detection for Early for Early Therapy of Invasive Aspergillosis in Therapy of Invasive Aspergillosis in High Risk High Risk Hematological Patients A Hematological Patients A Randomized Cont
5、rolled Randomized Controlled TrialTrial AuthorAuthor Jos Jos Mar aMar a Aguado 1 Lourdes V zquez 2 Mario Fern ndez Ruiz 1 Teresa Aguado 1 Lourdes V zquez 2 Mario Fern ndez Ruiz 1 Teresa 一项多中心随机对照研究比较PCR GM与血清GM在诊断驱动中的价值 主要结果 确诊 临床诊断 次要结果 死亡率 抗真菌药物的使用 在获得单个实验室诊断的阳性 结果 即给予HRCT检查和抢先抗真真菌治疗 连续两个PCR阳性考虑为
6、阳性 72小时后反复的粒缺发热的患者将给予经验性抗真菌治疗 撤药 尽管数据依然包含在次要结果的分析中 Clinical Infectious Diseases 2015 60 3 405 14Clinical Infectious Diseases 2015 60 3 405 14 应用于研究组的诊断和治疗流程应用于研究组的诊断和治疗流程 Copyright belong to ECCMID Conference Any business purposes is forbidden Copyright belong to ECCMID Conference Any business purpo
7、ses is forbidden European Congress of European Congress of Clinical Microbiology Clinical Microbiology and Infectious and Infectious DiseasesDiseases Diagnostic and therapeutic algorithms applied in the study groupsDiagnostic and therapeutic algorithms applied in the study groups 急性淋巴细胞白血病或多发性骨髓瘤化疗诱
8、导期 异基因造血干细胞移植患者 血清GM和PCR检测 2次 周 GM检测组 仅给予GM 检测 联合检测组 给予GM和 PCR检测 GM和 或 PCR阳性 继续给予 监测 胸部HRCT扫描 给予IA的抗真菌 治疗 胸部HRCT扫描 给予IA的抗真菌 治疗 继续给予 监测 GM 阳性 抗抗真菌治疗和曲霉菌感染患者死亡率贡献真菌治疗和曲霉菌感染患者死亡率贡献 Copyright belong to ECCMID Conference Any business purposes is forbidden Copyright belong to ECCMID Conference Any busines
9、s purposes is forbidden European Congress of European Congress of Clinical Microbiology Clinical Microbiology and Infectious and Infectious DiseasesDiseasesUse of Antifungal Therapy Other Than Use of Antifungal Therapy Other Than Fluconazole ProphylaxisFluconazole Prophylaxis and Overall and Invasiv
10、e Aspergillosis Attributable and Overall and Invasive Aspergillosis Attributable Mortality in the Per Protocol PopulationMortality in the Per Protocol Population GM PCRGM PCR组组GMGM组组 结果结果 抗真菌治疗的应用抗真菌治疗的应用 经验性治疗经验性治疗 诊断驱动治疗诊断驱动治疗 目标治疗目标治疗 其他指证其他指证 抗抗真菌治疗疗程 天真菌治疗疗程 天 Mean SDMean SD 经验性治疗经验性治疗 诊断驱动治疗诊断
11、驱动治疗 目标治疗目标治疗 随访终点患者死亡数随访终点患者死亡数 3030天死亡率天死亡率 180180天死亡率天死亡率 确证和临床诊断侵袭性曲确证和临床诊断侵袭性曲 霉病死亡贡献率霉病死亡贡献率 确证案例死亡确证案例死亡贡献率贡献率 临床诊断案例死亡临床诊断案例死亡贡献率贡献率 a 有8位患者PCR阳性但HRCT发现病灶但患者GM检测为 阴性 有10位患者PCR阳性 HRCT未发现病灶 患者GM 检测为阴性 1位患者HRCT发现病灶但患者GM检测为阳 性 b 4位患者IA的临床诊断 1位患者IA拟诊 c 8位患者接受了除抗曲霉治疗外的真菌治疗 4位患为氟 康唑预防治疗 入组后给予抗霉菌治疗
12、d 1个患者在拟诊为IA后12天死亡 该患者PCR阳性 HRCT高度提示阳性 两组患者确证两组患者确证和临床诊断侵袭性曲霉病患者生存率和临床诊断侵袭性曲霉病患者生存率 Copyright belong to ECCMID Conference Any business purposes is forbidden Copyright belong to ECCMID Conference Any business purposes is forbidden European Congress of European Congress of Clinical Microbiology Clinic
13、al Microbiology and Infectious and Infectious DiseasesDiseases Proven or probable invasive aspergillosis free survival Kaplan Meier curves in both study groups per protocol Proven or probable invasive aspergillosis free survival Kaplan Meier curves in both study groups per protocol population log rank population log rank test P test P 027 027 确诊 临床诊断患者生存率 时间 天
