肺曲霉菌病31例临床特点与诊治分析

发布时间：2018-03-26 08:21

本文选题：肺曲霉菌病　切入点：诊断　出处：《疑难病杂志》2016年04期

【摘要】：目的探讨肺曲霉菌病的临床特点及诊断方法,提高对本病的诊断准确性,减少误诊。方法回顾性分析2005年1月—2015年1月在首都医科大学宣武医院诊断为肺曲霉菌病的住院患者31例,结合文献分析,总结其临床表现、影像学特征及诊疗方法等。结果 31例患者中,有基础疾病29例(93.55%),无基础疾病2例(6.45%)。主要症状为呼吸道感染,主要体征为双肺干、湿性哕音。31例患者中初诊误诊28例(90.32%),经肺组织活检病理学确诊10例(32.25%),经支气管镜痰培养确诊12例(38.70%),经GM试验结合临床特征明确诊断6例(19.35%),经口痰涂片找到真菌3例(9.68%)。诊断为侵袭性肺曲霉菌16例,变应性支气管肺曲霉菌病10例,肺曲霉菌球5例。实验室检查主要有血清球蛋白水平降低,胸部CT示双肺病变18例(58.06%),左肺病变2例(6.45%),右肺病变11例(35.48%)。31例患者中,行外科手术切除治疗6例,行部分病灶切除治疗后给予伏立康唑治疗6例,余19例患者给予伏立康唑治疗。治愈17例,好转10例,无变化3例,死亡1例。结论肺曲霉菌病起病隐匿,临床表现缺乏特异性,很容易误诊和漏诊。提高对该病的认识,恰当应用有效的诊断方法,给予正确的诊断是进行有效治疗,降低病死率的关键。
[Abstract]:Objective to explore the clinical features and diagnostic methods of pulmonary aspergillosis and to improve the accuracy of diagnosis of this disease. Methods 31 cases of pulmonary aspergillosis diagnosed in Xuanwu Hospital of Capital Medical University from January 2005 to January 2015 were analyzed retrospectively. Results among the 31 patients, 29 had basic diseases (93.55g) and 2 had no underlying diseases (6.45g). The main symptoms were respiratory tract infection, and the main signs were double lung trunk. Of the 31 patients with phlegm, 28 were misdiagnosed (90.32), 10 were diagnosed by lung biopsy pathology, 12 by bronchoscopy sputum culture, 6 by GM test combined with clinical features, and 3 fungi were found by oral sputum smear. 16 cases of invasive pulmonary aspergillus were diagnosed. There were 10 cases of allergic bronchopulmonary aspergillosis and 5 cases of pulmonary aspergillosis. Laboratory examination mainly showed a decrease in serum globulin level, chest CT showed 18 cases with double lung disease, 2 cases with left lung disease and 6.455.31 cases with right lung disease. 6 cases were treated with surgical resection, 6 cases were treated with fulconazole after partial lesion resection, and the remaining 19 cases were treated with fulconazole. 17 cases were cured, 10 cases were improved, 3 cases were unchanged. Conclusion Pulmonary aspergillosis has hidden onset and lack of specificity. It is easy to misdiagnose and miss diagnosis. To improve the understanding of the disease, to properly apply effective diagnostic methods, and to give correct diagnosis is effective treatment. The key to reducing mortality.
【作者单位】：首都医科大学宣武医院呼吸科;
【分类号】：R519.8

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