肺毛霉病临床诊断学特征分析并文献复习  

Clinical diagnostics features of pulmonary mucormycosis and literature review

作　　者：武薇[1,2] 李钊[2] 邵长周[1] 姜鲁宁[2] 吕高超[2] 李勇[3] 

机构地区：[1]复旦大学附属中山医院呼吸科,上海200032 [2]济宁医学院附属医院呼吸科,272029 [3]济宁医学院附属医院急诊科,272029

出　　处：《中华诊断学电子杂志》2016年第4期272-276,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：上海市自然基金(13ZR1406600)

摘　　要：目的通过分析肺毛霉病的临床症状、影像学表现、诊断、治疗和预后,提高对该病的认识。方法回顾性分析2007年1月至2015年12月收治的6例肺毛霉病患者的临床资料并复习国内外文献。结果 6例均为中老年患者,病程26 d至14个月。1例无基础疾病,1例有肺结核病史,1例有慢性阻塞性肺疾病病史,1例有免疫性血小板减少症,3例有血糖升高,其中1例发病时合并有糖尿病酮症酸中毒。临床症状有咳嗽、咳痰、发热、咯血等。影像学表现:双肺团块、结节影2例,双肺多发斑片状阴影1例,单一团块病灶伴空洞2例,双肺结节伴空洞1例,胸腔积液3例,心包积液2例。6例均通过病原学或组织病理确诊,并应用两性霉素B或两性霉素B脂质体治疗,5例症状好转;1例合并有脑毛霉感染,联合应用泊沙康唑治疗,肺部症状有缓解,最终死亡。结论肺毛霉病临床及影像学表现缺乏特异性,通过气管镜或肺穿刺进行病原学诊断是该病的有效确诊手段。治疗的关键在于早期诊断、控制基础疾病、及时应用两性霉素B。Objective To enhance the recognition of pulmonary mucormycosis（PM） by analyzing the clinical symptoms, imaging features, diagnosis, treatment and prognosis of this disease. Methods The clinical data of 6 patients suffering from PM during January 2007 and December 2015 were retrospectively analyzed and the related literatures were reviewed.Results All these 6 cases were elderly patients,course of disease was 26 days to 14 months.One patient had no underlying diseases,1 patient had pulmonary tuberculosis,1 patient had COPD history,1 patients had immune thrombocytopenia,3 patients had high blood glucose and 1 of the 3 patients had diabetic ketoacidosis during development of PM.The clinical symptoms included cough, expectoration,fever,hemoptysis,etc. Imaging features showed that 2 cases had mass and nodules in double lung,1 cases had multiple patchy shadow in double lung,single mass lesions with holes in 2 cases,double lung nodules with cavity in 1 case,pleural effusion in 3 cases,pericardial effusion in 2 cases.Amphotericin B or liposomal amphotericin B was used in all the patients for therapy, and symptoms of 5 cases improved. Posaconazole was used as combined therapy in 1 cases complicated with cerebral mucormycosis. The symptoms of the lung improved but the patients died at last.Conclusions The clinical and imaging features of the PM are lack of specificity.Bronchoscopy or lung biopsy is an effective method for the diagnosis of PM. Early diagnosis, control of underlying diseases, timely application of amphotericin B are the key of its treatment.

关 键 词：肺毛霉病 体征和症状 影像学 两性霉素B 

分 类 号：R519[医药卫生—内科学]