53例诺卡菌感染病例临床特征分析  

Clinical characteristics of 53 cases of Nocardia infection

作　　者：谢祎[1] 侯雪新[2] 徐帅[2] 张景山[2] 刘爱忠[1] 李振军[2] 

机构地区：[1]中南大学湘雅公共卫生学院,湖南长沙410013 [2]中国疾病预防控制中心传染病预防控制所,北京102206

出　　处：《疾病监测》2015年第1期14-18,共5页Disease Surveillance

基　　金：中国疾病预防控制中心新时期我国实验室生物安全重要问题及其对策研究(No.201302006);基于全基因组序列的细菌分型技术(No.2013ZX10004221)~~

摘　　要：目的探讨诺卡菌感染的临床表现、实验室检查、影像学特点及诊断、治疗、预后。方法检索1998-2013年国内医学数据库所报道的53例诺卡菌感染病例的相关文献并对其进行回顾性分析。以既往患病的诺卡菌病例为研究组,既往体健的诺卡菌病例为对照组,对比分析两组的临床表现,影像学特征及治疗转归情况。结果 53例诺卡菌病例中,31例存在基础疾病。研究组与对照组临床表现除凹陷性水肿差异有统计学意义(χ2=4.442,P<0.05),其他无统计学意义。药敏试验结果提示菌株对复方磺胺甲恶唑-甲氧苄啶(TMP-SMX)、阿米卡星、米诺环素等敏感。两组病例间死亡率的比较差异有统计学意义(χ2=4.576,P<0.05)。结论诺卡菌感染部位多见于肺,其临床特点无明显异质性,预后存在明显异质性,复方磺胺甲恶唑仍然是治疗诺卡菌感染的首选药物,临床上对于可疑病例应及早进行相关病原学检查。Objective To discuss the clinical manifestations, laboratory examination and imageological characteristics, diagnosis, treatment and prognosis of nocardiosis. Methods Retrospective analysis was conducted on the clinical data of 53 cases of Nocardia infection reported in national medical database from 1998 -2013. The study group included nocardiosis patients with disease histories and the control group included the nocardiosis patients who were previously healthy, their clinical manifestations, imageological characteristics and treatment outcomes were compared. Results Among the 53 nocardiosis cases, 31 were with underlying diseases. Although the difference in pitting edema was statistically significant between the study group and control group （X^2 = 4. 442, P 〈 0. 05 ）, the differences in other clinical manifestations had no statistical significances between two groups. The drug susceptibility test results indicasted that Nocardia was sensitive to sulfamethoxazole-trimethopfim （TMP-SMX）, amikacin, minocycline and so on. The difference in death rate between two groups was statistically significant （X^2 = 4. 576,P 〈 0. 05 ）. Conclusion The lungs are mainly affected by nocardiosis. No obvious heterogeneity in clinical manifestations was observed, but prognosis had obvious heterogeneity. Snlfamethoxazole is still a choice for Nocardia infection treatment. It is necessary to conduct early pathologic examination for clinical suspected nocardiosis cases.

关 键 词：诺卡菌 病例报告 病例分析 

分 类 号：R378[医药卫生—病原生物学]