2型糖尿病合并毛霉菌病的临床分析
Clinical analysis of type 2 diabetes mellitus-associated mucormycosis

摘要：目的 分析2型糖尿病合并毛霉菌病的临床特点和预后并结合国内外相关文献报道，进一步加深对疾病的认识并提高早期诊断水平。方法 回顾性分析6例2型糖尿病合并毛霉菌病患者的临床资料。结果 6例患者中，分别为随机血糖>13mmol/L(6/6)、发热(6/6)、酮症(6/6)、白细胞升高(6/6)、酸中毒(5/6)，头颅核磁共振(MRI)和胸部计算机断层扫描(CT)无特征性表现，真菌涂片阳性(3/6)，病理活检阳性(5/6)，早期应用两性霉素B配合局部清创、手术治疗治愈率(5/6)。结论 2型糖尿病合并毛霉菌病的诊断要点为随机血糖>13mmol/L、糖化血红蛋白>10%、酸中毒、白细胞升高及进行局部组织病理活检。早期足量应用两性霉素B和进行局部病变的手术治疗是治愈的关键。
ABSTRACT: Objective To analyze the clinical characteristics and progress of patients with type 2 diabetes mellitus-associated mucormycosis and to gain a better understanding of the disease by literature review. Methods A retrospective analysis was conducted in 6 patients treated for type 2 diabetes mellitus-associated mucormycosis. Results Six cases in our hospital had clinical data of type 2 diabetes mellitus-associated mucormycosis. We found random blood glucose >13mmol/L (6/6), fever (6/6), ketoacidosis (6/6), elevated leukocytes count (6/6), acidosis (5/6), positive fungal smear (3/6), positive pathological biopsy (5/6), and no skull MRI or chest CT characteristic manifestation. All the patients were treated with amphotericin B and surgical treatment, with the curative rate of 5/6. Conclusion Type 2 diabetes mellitus-associated mucormycosis is characterized by tendency for random blood glucose >13mmol/L, glycosylated hemoglobin>10%, ketoacidosis, acidosis, elevated leukocytes count, and pathological biopsy. Early and sufficient amount of liposomal amphotericin B and surgical treatment on local lesion are the key to treatment