肺毛霉病五例及国内46例临床分析  

Pulmonary mucormycosis： report of 5 cases and review of 46 cases reported in China

作　　者：杨翼萌[1] 方保民[1] 许小毛[1] 方芳[1] 潘明鸣[1] 钟雪锋[1] 孙铁英[1] 

机构地区：[1]北京大学第五临床医学院卫生部北京医院呼吸与危重症医学科,100730

出　　处：《中华结核和呼吸杂志》2013年第8期572-576,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的总结肺毛霉病的临床特征，探讨其早期诊断方法及合理的治疗方案。方法报道北京医院收治的5例肺毛霉病确诊病例的临床表现、治疗经过和转归，并以“肺毛霉病”为关键词检索万方数据库和中国期刊全文数据库（1982年1月至2011年12月）。结果5例肺毛霉病患者主要表现为咳嗽、发热、咯血，其中2例经支气管镜肺活检、1例经CT引导下经皮肺活检、1例经外科手术确诊，1例经血培养确诊。5例中3例经抗真菌治疗后痊愈，1例外科手术后治愈，1例死亡。在万方数据库和中国期刊全文数据库进行检索，共检索到国内发表的有关肺毛霉病的论文42篇，符合确诊标准的46例。51例中男31例，女20例，平均年龄（47±13）岁；主要危险因素为糖尿病（18例）、使用免疫抑制药物（7例）、恶性肿瘤（5例）及肾脏疾病（5例）；主要影像学表现为结节影（27例）和斑片状实变影（21例）及空洞（18例）；血白细胞或中性粒细胞比例增高者26例；18例经支气管镜、15例经外科手术、7例经CT引导下经皮肺活检、4例经尸检、1例经肾脏穿刺及1例经皮肤活检确诊，3例经胸腔积液培养、2例经血培养确诊；12例单独使用低剂量两性霉素B脂质体或联合泊沙康唑治疗的患者效果均较好且耐受性好，单纯手术治疗及药物联合手术治疗的14例患者均康复出院。结论肺毛霉病患者临床表现缺乏特异性，支气管镜检查及CT引导下经皮肺活检是诊断肺毛霉病的有效手段。单独使用低剂量两性霉素B脂质体或联合泊沙康唑治疗效果均较好且耐受性好，手术治疗效果较好。Objective To describe the clinical manifestations and diagnosis of pulmonary mucormycosis. Methods We presented 5 proven diagnosed cases of pulmonary mucormycosis in our hospital and reviewed all proven cases of pulmonary mucormycosis previously reported in China's Mainland. Publications in the form of case reports and articles between January 1982 and December 2011 were searched from Wan Fang Data and China Hospital Knowledge Database. Results Of the 5 patients in our hospital, the main symptoms included cough, fever, and hemoptysis. Two cases were diagnosed by transbronchial lung biopsy （TBLB） , 1 by surgery, 1 by CT-guided percutaneous lung biopsy, and 1 by blood culture. Three patients were cured by antifungal chemotherapy alone, 1 was cured by surgery, and 1 died. Forty-six proven diagnosed cases of pulmonary mucormycosis were retrieved from Wan Fang Data and China Hospital Knowledge Database using key word （pulmonary mucormyeosis）. Of the 51 patients in total, there were 31 males and 20 females, with a mean age of （47 ± 13）years. The most common risk factors for pulmonary mucormyeosis were poorly controlled diabetes mellitus （ 18 cases ）, administration of immunosuppressants （7 cases）, malignancy （5 cases） and kidney diseases （ 5 cases ）. Chest CT showed nodules （ 27 cases ）, infihrates（21 cases）, and cavities （18 cases）. White blood cell count and neutrophil percentage were elevated in 26 patients. Eighteen cases were diagnosed by histological study of transbronchial biopsy or TBLB specimen. The diagnosis was proven with surgical specimen in 15 patients, CT-gnided pereutaneous lung biopsy specimen in 7 patients, autopsy in 4 patients, skin biopsy in 1 patient, and renal biopsy in one patient. Three cases were diagnosed by pleural effusion cultures and 2 were diagnosed by blood cultures. Administration of low-dose liposomal amphotericin B （AMB） alone or combined with posaconazole in 12 patients were effective and safe. Fourteen patients who had received surgical

关 键 词：毛霉菌病 两性霉素B 泊沙康唑 

分 类 号：R519[医药卫生—内科学]