播散型组织胞浆菌病临床特点与药物治疗  

Clinical Characteristics and Pharmacotherapy of Disseminated Histoplasmosis

作　　者：熊先智[1] 蔡淑清[2] 金阳[1] 张建初[1] 白明[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院呼吸科,武汉430022 [2]华中科技大学同济医学院附属协和医院传染科,武汉430022

出　　处：《医药导报》2006年第12期1273-1275,共3页Herald of Medicine

摘　　要：目的分析总结组织胞浆菌病例的临床特点,以提高对该病的诊疗水平。方法收集8例确诊并资料完整的病例,进行回顾性分析总结。结果组织胞浆菌病特点如下:患者长期发热,多系统损害,消化、血液和呼吸系统常受累,出现相应的症状和贫血貌、消瘦、皮肤出血点和肝脾肿大等体征;轻度贫血,外周血白细胞总数不增高或偏低,中性粒细胞比例<0.73,杆状核粒细胞偏高,淋巴细胞减少或正常,单核细胞比例偏高,C-反应蛋白增高程度明显高于血沉,血IgG升高,血浆清蛋白/球蛋白(A/G)比值降低;特殊检查以肝脾和腹腔淋巴结肿大为主,肝CT密度值下降疑似脂肪肝。结论具有上述临床特征的患者应进行油镜下骨髓细胞学检查,在巨噬细胞内发现组织胞浆菌,并经骨髓真菌培养,见双相生长的真菌而确诊。治疗用两性霉素B,总剂量约350 mg,疗效极佳。Objective To analyze and sum up the clinical characteristics of disseminated histoplasmosis （DH） so as to improve the levels of diagnosis and treatment of the disease. Methods Retrospective analysis and summing up of the complete clinical data of 8 inpatients with DH were carried out the diagnosis of which had been confirmed by bone marrow cytomorphology and/or bone marrow fangus cultivation. Results and Conclusion The clinical characteristics of the 8 cases of DH were. as follows： ① Long term fever associated with muhisystem affection, the digestive, blood and respiratory systems being frequently compromised. The corresponding symptoms and signs included anaemic countenance, emaciation, dermatorrhagia and splenohepatomegaly. ② Mild anemia, the total number of WBC in the peripheral blood was not increased or slightly decreased. The percentage of neutrophil granulocytes was less than 0.73, with a relative increase in the stab-form granuloeytes. The number of lymphocytes was decreased or normal, while the percentage of monocytes was increased. ③The extent of the increase in C- reactive protein was strikingly greater than that of the acceleration of erythrocyte sedinentation rate. The plasma IgG increased while the serum A/G ratio decreased. ④Special instrumental examinations revealed splenohepatomegaly and enlarged abdominal lymphoid nodes. A reduced liver CT density suggested fatty liver. Bone marrow cells taken from patients with clinical manifestations described above were subjected to cytomorphologic examination under the oil immersion objective of the light microscope. The diagnosis of histoplasmosis was confirmed by the finding of the biphasic fungus growth in the culture of the Histoplasma capsulatum demonstrated in the macrophages. The disease was treated with amphotericin B with a total dose of round 350 mg, the therapeutic effect being excellent.

关 键 词：组织胞浆菌病 发热 肝大 脾大 两性霉素B 

分 类 号：R379.9[医药卫生—病原生物学]