10例低危宿主伪膜性气管支气管曲霉菌病分析  

Pseudomembranous tracheobronchial aspergillosis in 10 low risk hosts

作　　者：吴欢欢[1] 叶君如[1] 周颖[1] 叶民[1] 李玉苹[1] 陈成水[1] 

机构地区：[1]温州医学院附属第一医院呼吸内科,浙江温州325000

出　　处：《中华医院感染学杂志》2012年第10期2044-2046,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨低危宿主伪膜性气管支气管曲霉菌病(PMATB)的临床特点、支气管镜、影像学表现及治疗。方法收集温州医学院附属第一医院2002年1月-2011年7月病理组织学确诊的10例PMATB临床资料。结果男4例,女6例,年龄37～72岁,平均(54.8±14)岁;以咳嗽、发热和呼吸困难,肺部干湿性啰音为主;血白细胞(20.37±7.61)×109/L,C反应蛋白(127.55±63.91)mg/L,血半乳甘露聚糖检测(GM)水平为1.36±0.95,支气管镜表现以灰白色伪膜和气道黏膜炎症为主,伪膜活检组织学和支气管镜刷检均找到曲霉菌丝;影像学病情初始时可完全正常,但所有患者易进展,表现为沿着气道分布的渗出、实变和结节,部分形成空洞;10例PMATB均静脉使用抗真菌药物,气管切开呼吸机支持4例,死亡3例,治愈7例。结论低危宿主PMATB易误诊,支气管镜以不同程度的伪膜附着和气道黏膜炎症为主,活检易找到曲霉菌菌丝,PMATB治疗在于早期诊断,采取有效的抗真菌药物,气管切开呼吸机支持患者预后较差。OBJECTIVE To investigate the clinical features,bronchoscopic and radiographic manifestation as well as the treatment of pseudomembranous tracheobronchial aspergillosis in low-risk hosts.METHODS The clinical data of 10 patients with PMATB confirmed by pathologic examination in the First Affiliated Hospital of Wenzhou Medical College between Jan 2002 and Jul 2012 were retrospectively studied.RESULTS The main symptoms and signs of the disease were cough,fever dyspnea wheezing and crackles.WBC counts and CRP level were（20.37±7.61）×10^9/L and（127.55±63.91）mg/L respectively.Serum galacto-mannan（GM） value was（1.36±0.95）,the bronchoscopic examination disclosed white and gray pseudomembrane adhered to the airway and a hyperemic,edematous airway membrane.Pathologic examination of the biopsy pseudomembrane in 10 cases disclosed aspergillus hyphae.Radiographic findings were normal or only revealed slight abnormal at the beginning of the PMATB.But with disease progressed,CT of 10 cases revealed multifocal consolidation,and nodules with a peribronchial distribution.3 cases followed by the development of cavitation.After confirmed PMATB,all patients received intravenous antifungal treatment,4 cases received tracheotomy and supported with mechanical ventilation,3 cases died,7 cases were cured.CONCLUSION PMATB in low-risk hosts is often misdiagnosed.PMATB has some clinical features in CT scan findings progress rapidly,especially reveal multifocal consolidation,and nodules with a peribronchial distribution.Under bronchoscope,there is typically pseudomembrane adhered to the airway and a diffuse tracheobronchitis.Early anti-fungal treatment may improve the prognosis of the patients with tracheotomy ventilator support.

关 键 词：气管支气管曲霉菌病 临床 支气管镜 影像学 

分 类 号：R181.32[医药卫生—流行病学]