奴卡菌病2例及国内67例临床特征分析

发布时间：2018-08-12 19:57

【摘要】：目的:总结奴卡菌病的临床特征,探讨其早期诊断及合理治疗方案,以提高临床诊治成功率。方法:报道我院收治确诊的2例奴卡菌病的临床表现、治疗和转归,并以“奴卡菌病”为关键词检索维普网、万方数据库、中国知网数据库(2002年12月至2016年6月),以“Nocardiosis”搜索Pub Med数据库。结果:共检索到国内已发表确诊为奴卡菌病病例67例。男40例,女27例;病变局限于肺40例,播散至皮肤13例,播散至脑4例,播散至心包1例,播散2个器官以上5例,肺外4例。主要危险因素为免疫抑制剂用药史36例、肺部疾病9例、HIV6例、器官移植2例。肺部影像学主要表现为斑片28例、结节22例、空洞17例、胸水13例、实变11例、肿块7例。确诊通过无菌体液37例、痰培养16例、支气管镜10例、肺穿4例、活检2例。单用磺胺治疗25例,好转17例;以磺胺为基础联合用药治疗25例,好转14例。磺胺无效改为利奈唑胺治疗5例,好转5例。结论:奴卡菌病患者临床表现缺乏特异性,无菌体液、组织送检能提高奴卡菌诊断率。治疗首选磺胺,对于免疫功能低下的患者早期主张联合用药,存在中枢神经系统感染患者应选利奈唑胺等血脑屏障穿透性好的药物。早期联合用药、足疗程使用能提高患者生存率。
[Abstract]:Objective: to summarize the clinical features of nocariasis and to explore its early diagnosis and reasonable treatment in order to improve the success rate of clinical diagnosis and treatment. Methods: the clinical manifestations, treatment and outcome of 2 cases of Nukaricosis diagnosed in our hospital were reported. China knowledge Network database (December 2002 to June 2016), search for Pub Med database with "Nocardiosis". Results: a total of 67 reported confirmed cases of Nukarycosis were found in China. The lesions were localized in the lung (n = 40), disseminated to the skin (n = 13), brain (n = 4), pericardium (n = 1), more than 2 organs (n = 5) and extrapulmonary (n = 4). The main risk factors were 36 cases of immunosuppressive drugs, 9 cases of pulmonary diseases, 6 cases of HIV and 2 cases of organ transplantation. The main imaging findings of the lung included macula in 28 cases, nodules in 22 cases, cavity in 17 cases, pleural effusion in 13 cases, consolidation in 11 cases and mass in 7 cases. 37 cases were confirmed by aseptic fluid, 16 cases by sputum culture, 10 cases by bronchoscopy, 4 cases by lung puncture and 2 cases by biopsy. 25 cases were treated with sulfanilamide alone, 17 cases were improved, 25 cases were treated with sulfanilamide and 14 cases improved. Sulfanilamide failed to be treated with linazolamide in 5 cases and improved in 5 cases. Conclusion: the clinical manifestation of the patients with Nuccariasis is lack of specificity, aseptic body fluid, tissue examination can improve the diagnosis rate of Nukarycas. Sulfanilamide is the first choice for the treatment of immunocompromised patients, and the patients with central nervous system infection should choose drugs with good penetration of blood-brain barrier, such as linazolamine. Early combined use of full course of treatment can improve the survival rate of patients.
【作者单位】：重庆医科大学附属第一医院第一分院呼吸内科;重庆医科大学附属第一医院呼吸内科;
【分类号】：R379.1

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