孢子丝菌病的临床及病理研究（附30年病例复习）

发布时间：2018-04-25 13:16

本文选题：孢子丝菌病 + 申克氏孢子丝菌　；参考：《吉林大学》2012年硕士论文

【摘要】：背景：孢子丝菌病是一种由申克氏孢子丝菌引起的人畜共患的真菌感染性疾病，可引起皮肤、皮下组织和附近淋巴系统的感染，在世界范围内广泛分布，有时也可呈爆发流行。本病于1898年由美国的Shenck首先报道，并且分离出了病原菌。1951年杨国亮在上海报道了1例皮肤孢子丝菌病。1955年刘春林报道了1例皮肤和肺孢子丝菌病，是国内首例报道系统性孢子丝菌病，并且对本病的病原菌、临床表现和病理改变做了重点的研讨。1986年，王氏于国内首次报道了扫描电镜观察申克氏孢子丝菌的研究。由于本病皮损形态多样，故在临床中易于误诊及漏诊。所以，我们有必要对本病的特点进行全面、综合的研究与分析，为进一步的研究和流行病防治提供理论依据。目的：通过对我院30年间（1981-2010年）门诊临床及病理确诊为孢子丝菌病的1146例患者的临床及病理特点的回顾性分析，研究其流行病学特点及临床病理特征，并分析其原因，使大家更深刻地认识本病，为今后的工作带来指导及帮助。资料与方法：收集了我院30年间（1981-2010年）门诊临床及病理确诊为孢子丝菌病的患者1146例。对这些患者的临床及病理特点，包括性别、年龄、籍贯、发病时间、发病原因、发病部位、症状、体征、病理特点等进行统计并分析。结果： 1.一般资料 1.1发病性别有差异，男女之比为1:1.60，，女性多于男性。 1.2发病年龄参差不齐，最小为3.5个月，最大为87岁，以40岁左右青年人数最多。 1.3患者的职业中，农民897例(78.27%)，其他（学生、教师、干部等）249例（21.73%）。 1.4发病季节多见于冬春季，春季（2-4月）452例（39.44%），冬季（11-1月）279例（24.35%）。 1.5发病时间长短不一，最长为30年，最短为3周。 1.6发病年份集中于2005-2006年。 2.临床及病理特点 2.1发病前有外伤史者不多见，为542例（47.29%）。 2.2发病部位以四肢、面部最多见，上肢557例（48.60%），下肢44例（3.84%），颜面部403例（35.16%）。 2.3临床分型中，固定型较多见，为724例（63.18%）。 2.4皮损形态以结节最多见，为536例（46.77%），溃疡293例（25.57%），斑块155例（13.52%），肉芽肿32例（2.80%），结痂80例（6.98%），其它50例（4.36%）。 2.5自觉症状中，有疼痛感者与无自觉症状者人数相当，有疼痛感者397例（34.64%），无自觉症状者416例（36.30%）。 2.6病理类型中，以弥漫性多形细胞性肉芽肿最多，为635例（55.41%），表现为浆细胞增生显著，包括数量不等的中性粒细胞、嗜酸性粒细胞、浆细胞、上皮样细胞及多核巨细胞。 2.758例患者行PAS染色，阳性率为60.34%。 2.8成功随访追踪到971例患者，均治愈。 3.其他 142例患者行真菌培养，阳性率为88.73%。65例患者行孢子丝菌素试验，阳性率为73.85%。结论: 1、孢子丝菌病多发于冬春季节，多见于女性，且以农民为主。 2、孢子丝菌病多发生于身体暴露部位，如四肢、面部。 3、孢子丝菌病是由申克氏孢子丝菌感染引起，所以多与外伤有关。只因感染部位轻微而未引起患者的注意，致使统计结果中外伤史相对较低。 4、孢子丝菌病皮损形态多样，易与其他疾病相混，易于误诊、漏诊，临床工作中应提高警惕，做全相关检查项目。 5、患者的就诊时间较长，可能会耽误病情，这提醒我们应该早发现、早诊断、早治疗。 6、由于现代生活水平的提高，许多人开始重视自己的身体，使得近几年内患者人数逐渐上升。 7、只要遵医嘱坚持治疗，孢子丝菌病的预后，是相对令人满意的。
[Abstract]:Background : Sporotrichosis is a fungal infectious disease caused by human and livestock caused by Sporotrichosis schenci , which can cause infection of skin , subcutaneous tissue and nearby lymphatic system . It is widely distributed in the world . It has been widely distributed in the world .

Objective : To study the clinical and pathological characteristics of 1146 patients diagnosed by clinical and pathological diagnosis of sporotrichosis in our hospital for 30 years ( 1981 - 2010 ) . The epidemiological features and clinical pathological characteristics were studied .

Materials and Methods : 1146 patients with sporotrichosis were collected from the clinic and pathology of our hospital from 30 years ( 1981 - 2010 ) . The clinical and pathological characteristics of these patients , including sex , age , origin , onset time , pathogenesis , site , symptoms , signs and pathological characteristics were analyzed and analyzed .

Results :

1 . General information

1.1 There was a difference in the incidence of sex , the ratio of male and female was 1 : 1.60 , and the female was more than men .

1.2 The age of onset is uneven , the minimum is 3.5 months , the maximum is 87 years , and the number of young people around the age of 40 is the largest .

1.3 Among the patients ' occupation , there were 89cases ( 78.27 % ) of farmers and 249 ( 21.73 % ) of other students ( students , teachers , cadres , etc . ) .

1.4 In winter and spring , 452 cases ( 39.44 % ) in spring ( 2 - April ) and 279 cases ( 24.35 % ) in winter ( 11 - January ) .

1.5 The duration of the disease is short , the longest is 30 years , and the shortest is 3 weeks .

1.6 The year of onset is concentrated in 2005 - 2006 .

2 . Clinical and pathological characteristics

2.1 There were no more trauma history before onset , 542 cases ( 47.29 % ) .

2.2 The most common cases were limbs and face , 557 cases of upper extremities ( 48.60 % ) , 44 cases of lower limbs ( 3.84 % ) and 403 cases ( 35.16 % ) .

2.3 In clinical classification , the fixation type was more frequently seen in 724 cases ( 63.18 % ) .

2.4 The lesions were found in 536 cases ( 46.77 % ) , ulcer 293 cases ( 25.57 % ) , plaque 155 cases ( 13.52 % ) , granuloma 32 cases ( 2.80 % ) , scab 80 cases ( 6.98 % ) and other 50 cases ( 4.36 % ) .

2 . In the self - conscious symptoms , there were 397 ( 34.64 % ) patients with pain feeling and no conscious symptom , 416 cases ( 36.30 % ) with no conscious symptoms .

In the 2.6 pathological types , the most abundant , 635 cases ( 55.41 % ) were diffuse and multi - cell granuloma , including neutrophils , eosinophils , plasma cells , epithelioid cells and multinucleated giant cells .

2.758 patients were stained with PAS and the positive rate was 60.34 % .

2.8 Successful follow - up tracing to 971 patients was cured .

3 . Other

The positive rate was 88.73 % . In 65 patients , the positive rate was 73.85 % .

Conclusion :

1 . Sporotrichosis is more common in winter and spring season , mostly female , and mainly farmers .

2 . Multi - occurrence of sporotrichosis occurs in exposed parts of the body , such as limbs and faces .

3 . Sporotrichosis is caused by the infection of Sporotrichosis schwanensis , so it is related to trauma . Due to the slight infection site , the patient ' s attention is not caused , so that the history of trauma is relatively low .

4 . It is easy to be misdiagnosed , missed diagnosis , and clinical work should be more vigilant in clinical work , so as to do all - related examination items .

5 . The patient ' s visit time is long and may delay the condition , which reminds us that early diagnosis and early treatment should be found .

6 . Due to the improvement of modern living standard , many people begin to attach importance to their own body , so that the number of patients has gradually increased in recent years .

7 . As long as the doctor ' s instructions adhere to the treatment , the prognosis of sporotrichosis is relatively satisfactory .

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R756.6

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