42例肺曲霉菌病临床特点分析

发布时间：2018-04-24 16:48

本文选题：肺部感染 + 宿主因素　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的通过对42例确诊肺曲霉菌病例宿主因素、临床表现和影像学特点、GM试验、G试验、微生物培养、治疗方法、死亡危险因素的统计分析,探讨目前肺曲霉菌病临床特点,提高临床医生对肺曲霉菌病的认知程度,以降低误诊、漏诊率,为临床诊治提供依据。方法收集广西医科大学第一附属医院2003年1月至2012年12月出院病人诊断肺曲霉菌病病例共计213例(患者多次住院以一次统计)、排除门诊、留察肺曲霉菌病病例,选取行活体组织病理检查的确诊肺曲霉菌病病例42例,统计其基本情况和临床指标以及生存情况,然后对相关数据进行统计分析。结果(1)入选42例患者全部确诊,平均年龄47.1±14.5岁(16岁-65岁),男性18例(占42.85%),女性共24例(占57.14%),高发年龄段为50-59岁(占30.95%)。(2)42例确诊患者寄生性为29例(占69.04%),平均年龄38.3±12.5岁(16岁-56岁),侵袭性患者13例(占30.95%),平均年龄52.7±14.3岁(32岁-65岁)。侵袭性肺曲霉菌病宿主因素以使用类固醇激素(P=0.01)、免疫抑制剂(P=0.00)、抗生素(P=0.00)多见,寄生性肺曲霉菌病肺部基础疾病为宿主因素,肺结核占10.34%(P=0.03)、COPD占13.79%(P=0.03)、支气管扩张占13.79%(P=0.00)。(3)侵袭性肺曲霉病临床感染症状较明显,发热(P=0.00)呼吸困难(P=0.00)、肺部Up音(P=0.00)较常见,寄生性肺曲霉菌病以咯血(P=0.00)症状常见。(4)侵袭性肺曲霉病以多个病灶为主(P=0.00),形态常为团块状(P=0.00),病灶边缘多不清晰(P=0.04),位置以多叶或单侧双叶为主(P=0.04)：寄生性肺曲霉病影像学病灶以孤立、单个病灶(P=0.03)居多、单肺叶(P=0.01)为主,病灶特征以新月征(P=0.01)、空洞(P=0.02)为主。(5)42例患者中寄生性肺曲霉菌病患者行GM试验检查阳性者12例,阳性率为70.58%；G试验阳性者17例,阳性率为58.82%。侵袭性肺曲霉菌病行GM试验检查阳性者6例,阳性率为75%；G试验阳性者8例,阳性率为62.25%。40例患者行≥2次深部痰标本培养,12例真菌培养分离出曲霉菌,阳性率30%。BALF真菌培养16例,分离出曲霉菌6例,阳性率37.5%。(6)42例确诊患者取组织标本行病理检查,其镜下可见曲霉菌丝或曲菌菌落。取活检组织标本部位以右肺上叶19例最多,占45%。结论(1)近年来肺曲霉菌病发病例数有明显增加趋势,呼吸系统相关疾病占宿主因素中基础疾病首位。(2)侵袭性肺曲霉病感染症状较明显,寄生性肺曲霉菌病以咯血症状常见。(3)肺部CT影像学特征侵袭性肺曲霉病以多个病灶为主、形态常为团块状、病灶边缘多不清晰、位置以多叶或单侧双叶为主；寄生性肺曲霉病影像学病灶以孤立、单个病灶居多、单肺叶为主,病灶特征以新月征、空洞为主。(4)病灶组织病理学找到曲霉菌为确诊金标准,最常用取得标本的方法是手术和气管镜下经支气管壁取肺活检。(5)肺曲霉菌病误诊率高,确诊率低(19.71%)。(6)手术+术后抗真菌药物治疗较单纯抗真菌药物治疗疗效较好。
[Abstract]:Objective to investigate the clinical features of pulmonary aspergillosis by means of statistical analysis of host factors, clinical manifestations and imaging features of 42 cases of pulmonary aspergillosis, including GM test G test, microbial culture, treatment methods and death risk factors. To improve the cognition of pulmonary aspergillosis in order to reduce the rate of misdiagnosis and missed diagnosis and to provide the basis for clinical diagnosis and treatment. Methods 213 cases of pulmonary aspergillosis were diagnosed in the first affiliated Hospital of Guangxi Medical University from January 2003 to December 2012. Forty-two cases of pulmonary aspergillosis diagnosed by biopsy were selected and their basic situation, clinical indexes and survival conditions were analyzed. Results 1) all 42 patients were diagnosed. The mean age was 47.1 卤14.5 years old, 16 to 65 years old, 18 males (42.85%), 24 females (57.14%), and 29 cases (69.04%, 38.3 卤12.5 years of age, 16 to 56 years old) in the high incidence age group of 50 to 59 years old (30.9550.59 years old), and 13 cases of invasive patients (39.04 years old, mean age 38.3 卤12.5 years, 16 to 56 years old) and invasive patients (39.04 years old, 39.04 years old, mean age 38.3 卤12.5 years, 16 to 56 years old) and invasive patients (13 cases). The average age was 52.7 卤14.3 years old and 32 to 65 years old. The host factors of invasive pulmonary aspergillosis were the use of steroid hormone P0. 01, immunosuppressant P0. 00, antibiotic P0. 00. parasitic pulmonary aspergillosis was the host factor. Pulmonary tuberculosis accounted for 10.34% of the patients with COPD (13.79%), bronchiectasis 13.79%, bronchiectasis 13.79%, invasive pulmonary aspergillosis (P 0.00.P0. 00), fever P0. 00) dyspnea P0. 00m, pulmonary Up-tone P0. 00. Parasitic pulmonary aspergillosis with hemoptysis P0. 00. (4) invasive pulmonary aspergillosis mainly consists of multiple foci P0. 00G, the shape is often a lump of P0. 00P, the lesion margin is not clear, the location is multilobular or unilateral-lobed P0. 04: parasitic pulmonary aspergillosis shadow of P0. 04: parasitic pulmonary aspergillosis Imaging lesions to isolate, The main features of the lesions were crescent sign P0. 01 (P0. 02). Among the 42 patients with parasitic pulmonary aspergillosis, 12 were positive for GM test, 17 were positive for 70.58G test, and the positive rate was 58. 82B. the main results were as follows: (1) the main feature of the lesion was: crescent sign P0. 01 (P0. 01), cavitation P0. 02) among the 42 patients with parasitic pulmonary aspergillosis, the positive rate was 70.58 G test positive in 17 cases, and the positive rate was 58. 822%. In invasive pulmonary aspergillosis, 6 cases were positive for GM test, 8 cases were positive for 75 G test, and the positive rate was 62.25.40 cases were isolated from 12 cases of fungal culture by more than 2 deep sputum culture. The positive rate of fungal culture was 30%.BALF fungus culture in 16 cases. Six cases of Aspergillus were isolated and the positive rate was 37.5.The positive rate of Aspergillus or Aspergillus was detected by pathological examination in 42 cases of confirmed patients, and the mycelium or colony of Aspergillus could be found under microscope. Of the biopsy specimens, 19 cases were located in the upper lobe of the right lung, accounting for 4545%. Conclusion (1) the incidence of pulmonary aspergillosis has an obvious increasing trend in recent years, and the respiratory system disease is the first one among the host factors) the infection symptom of invasive pulmonary aspergillosis is obvious. Parasitic pulmonary aspergillosis: hemoptysis is common. 3) CT imaging features of invasive pulmonary aspergillosis are as follows: most of the lesions are mass shape, the edge of the lesion is not clear, and the location is multilobular or unilateral. The imaging lesions of parasitic pulmonary aspergillosis were isolated, with single focus, single lobe, crescent sign, cavity, histopathology finding aspergillus as the golden standard for diagnosis. The most commonly used methods for obtaining specimens were: the misdiagnosis rate of pulmonary aspergillosis was higher and the diagnosis rate was lower than 19.71%. The most common method of obtaining specimens was surgery and tracheoscopic transbronchial lung biopsy. 5) the effect of antifungal drugs after operation was better than that of simple antifungal therapy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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