肺毛霉病两例报告并文献复习

发布时间：2018-05-19 07:01

本文选题：肺毛霉病 + 临床特点　；参考：《中国呼吸与危重监护杂志》2017年02期

【摘要】：目的探讨肺毛霉病(PM)的临床特点和治疗措施,提高医务人员对该病的认识,降低病死率。方法回顾性分析济宁医学院附属医院呼吸科收治的2例PM患者的病历资料,同时进行相关文献复习。以"肺毛霉菌病"为检索词检索中国知网(CNKI)数据库,以"pulmonary mucormycosis"为检索词检索Pubmed数据库,检索时间为2000年1月到2016年6月。结果患者1,男性,2014年2月7日以"咳嗽、咳痰伴憋喘5 d"收入院。胸部计算机断层成像(CT)提示:右肺上叶结节,邻近右肺上叶尖段支气管截断。2014年2月16日行电子支气管镜检查,活检病理组织中见毛霉菌,确诊后给予两性霉素B治疗好转出院。患者2,女性,2015年1月16日以"咳嗽、咳痰伴发热10+d"收入院。胸部CT示双肺纹理增强、紊乱,双肺内见多发大小不等的圆形结节、空洞,边界清楚,其中最大空洞直径约1.8 cm,部分空洞内见软组织密度影。行CT引导下肺穿刺,穿刺病理组织回示大部分为坏死性肉芽组织,其中见真菌菌丝,符合毛霉菌感染。确诊后给予两性霉素B、伏立康唑、泊沙康唑治疗,效果欠佳,患者自动出院,1周后死亡。文献检索经过严格筛选,最终收集病历资料完整的6篇文献进行PM临床特点及治疗措施的归纳总结。PM患者临床表现无特异性,多合并基础疾病,从出现症状到确诊约需要37.5 d。CT以及组织病理学检查有助于早期诊断,及时抗真菌治疗有助于改善预后。结论 PM是一种罕见的侵袭性真菌病,病死率高,临床表现无特异性,早期诊断、及时治疗是降低病死率的关键。
[Abstract]:Objective to explore the clinical characteristics and treatment of pulmonary trichoderma (PMM), to improve the medical staff understanding of the disease and to reduce the mortality. Methods the medical records of 2 cases of PM in the Department of Respiratory, affiliated Hospital of Jining Medical College were analyzed retrospectively and the related literatures were reviewed. Using "Pulmonary Mucor Disease" as the key word to search the CNKI database of China, and "pulmonary mucormycosis" as the key word to search the Pubmed database, the retrieval time is from January 2000 to June 2016. Results patient 1, male, was admitted to the hospital on February 7, 2014 with "cough, expectoration and asthma for 5 days". Chest computed tomography (CT) showed that the right superior lobe nodule, adjacent to the apical segment of the right lung, was truncated. Electronic bronchoscopy was performed on February 16, 2014. Mucor was found in the pathological tissue of the biopsy. After diagnosis, amphotericin B was given for better discharge. Patient 2, female, admitted to hospital on January 16, 2015 with "cough, expectoration and fever for 10 days". Chest CT showed enhanced and disordered bilateral lungs with multiple round nodules of varying sizes and clear borders. The maximum diameter of the cavity was about 1.8 cm, and soft tissue density was found in some of the cavities. Lung puncture guided by CT showed that most of them were necrotic granulation tissue, mycelium was found, which was consistent with Mucor infection. The patients were treated with amphotericin B, volconazole and posaconazole. Literature Retrieval after strict screening, 6 articles with complete medical records were collected to sum up the clinical characteristics and treatment measures of PM. The clinical manifestations of PM patients were nonspecific and complicated with basic diseases. About 37.5 d.CT and histopathological examination were needed from the onset of symptoms to diagnosis, and timely antifungal treatment was helpful to improve the prognosis. Conclusion PM is a rare invasive fungal disease with high mortality and no specificity in clinical manifestations. Early diagnosis and timely treatment are the key to reduce mortality.
【作者单位】：济宁医学院;济宁医学院附属医院呼吸科;
【分类号】：R519

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