2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/656693摘要：侵襲性黴菌感染在免疫不良的病患有日益增加的趨勢，罹患血液腫瘤疾病的病患，在經過化學治療後常發生嗜中性白血球低下，類固醇等免疫抑制劑使用等等的情形，他們是發生難以治療甚至致命的侵襲性黴菌感染的高危險族群。侵襲性黴菌感染的快速增加且伴隨高死亡率，而目前的診斷方式及治療皆不盡理想。我們在這個三年前瞻性計畫中，擬針對高危險群病人建立本土的流行病學資料，並建立血液腫瘤科病人的標準化醫療模式以方便收案，達到提高診斷率，提早正確治療侵襲性黴菌感染，進而能改善病人的預後。同時收取檢體以研究發展及應用泛黴菌 (pan-fungus) 及特定黴菌(Aspergillus-specific and Candida-specific) 的快速診斷方式，包括抗原，抗體及核酸之偵測。特別是流式微珠陣列的快速多重鑑定方法，鑑別常見如Aspergillus spp., Fusariumspp., Mucor spp., Rhizopus spp., Rhizomucor pusillus, Penicillium marneffei 等黴菌，評估敏感性和特異性，並探討臨床應用的可行性。有了本土的疾病發生率，和評估了幾種分子診斷方法的敏感性和特異性之後，期能及時回饋給臨床端以提供病人治療策略之建議。希望借由臨床與研究的結合，加速檢驗工具於臨床應用性的評估，並建立本土特定病人群侵襲性黴菌感染的治療策略，能回答到底是預防性用藥(prophylaxis) 經驗性用藥(empirical) 還是先發制人的用藥(pre-emptive)最為理想。<br> Abstract: Fungi are increasingly recognized as major pathogens in immunocompromised orcritically ill patients. Invasive fungal infections (IFI) are a major cause of morbidity andmortality in patients with haematological malignancies as well as prolonged neutropenia orallogeneic stem cell recipients despite advance in medical care and introduction of newantufungal agents. Limitation in the availability and implementation of sensitive, rapid andnon-invasive diagnostic approaches is one of the main reasons. In this three-year project, weplan to active survey and establish epidemiological data of invasive fungal infections in atertiary hospital in Taiwan. We will establish and implement a standard of care for allhospitalized patients in the hemato-oncology wards, to improve the diagnostic rate usingcurrent available diagnostic methods such as high-resolution CT scanning of the chest,image for the sinus, galactomannan antigen assay. At the same time, we will collect clinicalspecimens to evaluate the performance of molecular diagnostic tools including theantigen-antibody and newly-developed nucleic acid detection ( microsphere-basedsuspension array). The target of rapid diagnostic methods will be either pan-fungus orpathogen-specific. The sensitivity and predictive values of each method will be determinedin the prospective cohort. In the second year, the results would timely feedback to theclinicians. With the exact incidence of disease, and evaluation of several methods ofmolecular diagnosis, we will establish antifungal strategy in selected high-risk patients basedon incidence of invasive fungal infection and feasibility of rapid, non-invasive diagnosticmethods. The strategy includes prophylaxis, empirical therapy and pre-emptive therapy.