原发性肺曲菌病9例临床分析及文献复习
发布时间：2018-07-23 15:16
【摘要】：目的：原发性肺曲菌病,在临床上比继发性肺曲菌病要少见得多,起病较隐匿,易被临床医师忽视。本文就原发性肺曲菌病临床资料进行分析,以进一步提高对此病的认识,减少漏诊、误诊。 方法：2000年1月至2011年12月在广西医科大学第一附属医院住院且经组织病理学确诊的9例原发性肺曲菌病患者的临床资料进行回顾性分析,分析其临床、影像学、病理学表现及实验室检查、治疗情况并结合国内外文献进行讨论。 结果：9例患者既往体健均无基础疾病史,免疫功能正常,无长期糖皮质激素、免疫抑制剂、抗生素使用史。9例均经组织病理学确诊。①女性5例,男性4例,年龄29-58岁,平均年龄(42±10)岁。②职业：农民7例(7/9)其中4例有较明确霉变、陈旧物品接触史,工人2例(2/9)。③临床特征：咯血8例(8/9),小量咯血3例,1-10mL/次不等,大咯血5例,最多可达200mL/次。咳嗽、咳痰8例(8/9),发热1例(1/9)最高体温达40℃,盗汗2例(2/9)。1例病变部位(左上肺)可闻及少许湿性Up音,余体格检查无特殊。④影像学：空洞7例,空洞内结节肿块影7例,“新月征”6例,小结节影1例,肿块影2例。病变部位：病变部位以上叶尖后段、下叶背段为主,病变可涉及多肺段多肺叶。增强后病灶均无强化。⑤实验室及器械检查：血常规、肝肾功能、肿瘤标记物正常。9例痰涂片找真菌、痰真菌培养(-)。9例肺功能检查正常,6例支气管镜示病灶处气管、支气管粘膜充血、水肿,9例患者中1例行血清真菌毒素葡聚糖总含量960.5pg/ml(参考值0-10)。⑥治疗：6例患者长期误诊为肺结核,最长达10余年,长期反复服用抗结核治疗,3例误诊肺癌,入院后6例行外科病灶切除术,其中两例术后联合伏立康唑、伊曲康唑、两性霉素B抗真菌治疗,3例单独行抗真菌治疗。⑦转归：5例术后治愈,其中1例术后因病灶未完全切除而再次行手术治疗治愈；1例术后联合抗真菌治疗好转；3例单一经抗真菌治疗后病情缓解,无死亡病例。 结论：1原发性肺曲菌病患者有重要的霉变陈旧物品吸入/接触史。 2原发性肺曲菌病起病多隐匿,慢性过程,进展相对缓慢。 3最常见的临床症状为咯血、咳嗽,发热等全身症状少见。 4影像学上以空洞、“新月征”、孤立肿块影为常见,发病部位以上叶尖后段、下叶背段为多见。 5纤支镜下管腔多受累,肺功能正常,气道反应性不高。 6病灶组织病理学找到曲菌丝即可确诊,手术和TBLB是最常用且有效的取得标本的方法。 7常误诊肺结核、肺癌。 8手术/抗真菌治疗疗效较好。
[Abstract]:Objective: primary pulmonary aspergillosis is much less common than secondary pulmonary aspergillosis in clinic. The clinical data of primary pulmonary aspergillosis were analyzed in order to further improve the understanding of the disease and reduce missed diagnosis and misdiagnosis. Methods: the clinical data of 9 patients with primary pulmonary aspergillosis who were hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2000 to December 2011 and confirmed by histopathology were analyzed retrospectively. Pathological findings, laboratory examination, treatment and the literature at home and abroad were discussed. Results 9 cases had no history of basic disease, normal immune function, no long-term glucocorticoid, immunosuppressant, antibiotic use history of 9 cases confirmed by histopathology in 5 cases, male 4 cases, age 29-58 years. The average age was (42 卤10) years 2 occupation: 7 cases (7 / 9) of peasants had definite mildew, 4 cases had a history of contact with obsolete materials, 2 cases (2 / 9) of workers had clinical characteristics: 8 cases (8 / 9) of hemoptysis, 3 cases of small volume hemoptysis ranged from 1-10 mL / time, 5 cases of massive hemoptysis, up to 200mL/ times. There were 8 cases of cough and expectoration (8 / 9), 1 case of fever (1 / 9) with the highest body temperature up to 40 鈩，
本文编号：2139807
[Abstract]:Objective: primary pulmonary aspergillosis is much less common than secondary pulmonary aspergillosis in clinic. The clinical data of primary pulmonary aspergillosis were analyzed in order to further improve the understanding of the disease and reduce missed diagnosis and misdiagnosis. Methods: the clinical data of 9 patients with primary pulmonary aspergillosis who were hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2000 to December 2011 and confirmed by histopathology were analyzed retrospectively. Pathological findings, laboratory examination, treatment and the literature at home and abroad were discussed. Results 9 cases had no history of basic disease, normal immune function, no long-term glucocorticoid, immunosuppressant, antibiotic use history of 9 cases confirmed by histopathology in 5 cases, male 4 cases, age 29-58 years. The average age was (42 卤10) years 2 occupation: 7 cases (7 / 9) of peasants had definite mildew, 4 cases had a history of contact with obsolete materials, 2 cases (2 / 9) of workers had clinical characteristics: 8 cases (8 / 9) of hemoptysis, 3 cases of small volume hemoptysis ranged from 1-10 mL / time, 5 cases of massive hemoptysis, up to 200mL/ times. There were 8 cases of cough and expectoration (8 / 9), 1 case of fever (1 / 9) with the highest body temperature up to 40 鈩，
本文编号：2139807
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