脳神経外科領域における真菌症，特に深在性真菌症に対する（1→3）-β-D-グルカン測定の有用性とフルコナゾール投与の重要性について

The Usefulness of Fluconazole Administration and β-D-glucan Measurement in Neurosurgical Patients with Deep-seated Mycosis

I．はじめに

　最近外科領域での真菌感染症が増加傾向を示している．元来外科領域における真菌感染症は大侵襲手術・多発外傷・重度熱傷・高齢者・多くの合併症を有する患者などのcompromised hostに多いといわれている^4）．しかし脳神経外科領域においては，これに加え意識障害などが加わり，より一層真菌感染症に対する留意が必要と考えられる．いままでは真菌感染症は初期の診断が困難で，その治療方針も確立されているとは言い難かった．そこでわれわれは最近，真菌感染症の早期診断にきわめて有用と言われている血清学的診断法（1→3）β-D-グルカンを測定し，真菌感染の有無を判断，陽性のものに対して抗真菌薬であるフルコナゾールを投与，その抗真菌効果を検討したので報告する．

The diagnostic usefulness of β-D-glucan values and the efficacy of flrconazole (FLCZ) were investi-gated in 20 patients with deep-seated mycosis treated in our neurosurgical department from Oct 1, 1997 to May 31, 1998. The diagnosis of deep-seated mycosis was carried out using mycological and serological methods.

When the serological β-D-glucan value was above 10pg/ml, the patient was considered to have deep-seated mycosis. In 13 patients (65%), the definite diagnosis of deep-seated mycosis was established by cul-ture. In 7 patients, diagnosis based on serological examination alone was false positive or false negative.FLCZ 200 or 400 mg per day was administered for 10 days. Three patients were administered 200 mg/day FLCZ for another 10 days.

No side effect of FLCZ was noticed among these patients. Three of 13 patients (23%) in whom fungi were isolated became fungi negative after FLCZ administration.

The mean β-D-glucan values before and after the administration of FLCZ were 36.37mg/ml and 13.75mg/ml, respectively. The β-D-glucan values before and after the administration of FLCZ were signi-ficantly correlated with statistics (Student's t-test; p＜0.001).

It was concluded that FLCZ was useful, and that β-D-glucan values generally reflected the therapeutic effect of FLCZ. In contrast to the mycological culture tests that provided only a low detection rate, β-D-glucan values were useful not only as a diagnostic means but also as a means to evaluate the efficacy of FLCZ treatment.