22例肺曲霉菌病误诊分析  

Misdiagnosis analysis of twenty-two cases with pulmonary aspergillosis

作　　者：姜鲁宁[1] 刘雪青[2] 张秀莲[1] 山凤莲[1] 党艳梅[3] 宋敏[1] 

机构地区：[1]济宁医学院附属医院呼吸科,272029 [2]济宁医学院,在读研究生272100 [3]济宁医学院附属医院肾内科,272029

出　　处：《中华诊断学电子杂志》2015年第3期47-51,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：济宁市科技局项目(2012jnnk02)

摘　　要：目的探讨肺曲霉菌病的临床特点和诊断方法,提高临床诊断能力。方法回顾性分析2007年1月至2014年4月济宁医学院附属医院呼吸科收治的22例肺曲霉菌病误诊患者的临床资料。结果 22例肺曲霉菌病患者全部初诊为其他疾病,其中初诊为细菌性肺炎16例(72.7%),疑诊为肺结核3例(13.6%),疑诊为肺癌或肺内转移瘤3例(13.6%)。患者临床表现:咳嗽、咳痰16例,喘息、呼吸困难13例,发热8例,咯血5例,胸痛2例,声音嘶哑2例。13例外周血白细胞计数增高,15例中性粒细胞比例升高,12例C反应蛋白(CRP)呈不同程度的增高;半乳甘露聚糖抗原检测(GM试验)阳性者6例。患者CT改变呈多样性,并呈动态演变。右肺病变9例,左肺病变2例;双肺病变11例,其中"空气新月征"6例,双肺多发的斑片状阴影5例,支气管轻度或中度扩张5例,单发或多发的大小不等的结节或肿块3例,"晕轮征"2例,"指套样"改变1例。另外,伴有肺气肿或肺大泡10例,肺门、纵隔淋巴结肿大有9例,多发或单发的空洞5例,合并单侧或双侧少至中等量胸腔积液4例。病原学检查发现,有9例深部痰标本直接镜检可见菌丝,其中烟曲霉5例,黄曲霉2例,两者均有2例,同时经痰真菌培养分离出曲霉菌3例;经BALF培养分离出曲霉菌3例,其中烟曲霉2例,黑曲霉1例;同时经痰真菌培养和BALF培养出曲霉菌者2例。电子支气管镜下肺活检病理确诊2例;CT引导下经皮肺穿刺活检病理确诊1例;外科手术后病理确诊1例。结论肺曲霉菌病起病隐匿,临床表现不典型,早期误诊率较高,应尽早完善病原学检查和组织病理检查以明确诊断。Objective To explore the clinical characteristics and diagnostic methods of pulmonary aspergillosis （PA） and improve the abilities of clinical diagnosis.Methods Retrospective review on clinical data of twenty-two misdiagnostic cases with pulmonary aspergillosis, which were admitted to Affiliated Hospital of Jining Medical University during January 2007 to April 2014. Results Twenty-two cases of pulmonary aspergillosis patients were diagnosed as other diseases primarily,including sixteen cases （72.7%） as bacterial pneumonia, three cases （ 13.6% ）as suspected tuberculosis and three cases （ 13.6% ）as suspected lung cancer or pulmonary metastasis. Clinical manifestations were as follows ： sixteen cases with cough and sputum,thirteen cases with gasp and dyspnea, eight cases with fever, five cases with hemoptysis, two cases with chest pain and two cases with hoarseness. White blood ceils in peripheral blood were high in thirteen cases;neutrophils ratio was high in fifteen cases, c-reactive protein （CRP） increased in twelve cases and galactomannan （GM） test was positive in six cases.Chest CT scans in patients were diverse and dynamic, including nine cases with right lung lesions, two cases with left lung lesions and eleven cases with double lung lesions.There were six cases with ＂air crescent sign＂, five cases with double lung multiple patchy shadows, five cases with mild or moderate bronchial expansion , three cases with a single or multiple nodules or masses ,two cases with ＂halo sign＂ and one case with ＂gloves sample changes＂ .In addition, ten cases were accompanied with emphysema or pulmonary bullae, nine cases were accompanied with lung door and mediastinal lymph node enlargement, five cases were accompanied with muhiple or single cavity and foul＇ cases were accompanied with unilateral or bilateral pleural effusion. Mycelium could be seen in sputum specimens of nine cases by deep microscopic examination, including aspergillus fumigatus in five cases, aspergillus flavus in two

关 键 词：肺曲菌病 曲霉菌属 误诊 诊断技术和方法 

分 类 号：R519[医药卫生—内科学]