侵袭性肺毛霉菌病诊治及预后分析  

Clinical charecteristics,diagnosis and treatment of invasive pulmonary mucormycosis

作　　者：姜华 李春梅 南岩东 李王平 金发光 Jiang Hua;Li Chunmei;Nan Yandong;Li Wangping;Jin Faguang(Department of Pulmonary and Critical Care Medicine,Tangdu Hospital,The Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学(第四军医大学)唐都医院呼吸与危重症医学科,西安710038

出　　处：《中华肺部疾病杂志（电子版）》2018年第6期659-663,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家公益性行业科研专项(201402024);第四军医大学唐都医院科技创新发展基金(2016JCYJ015)

摘　　要：目的探讨侵袭性肺毛霉菌病的临床特征、诊治方法和预后。方法回顾性分析空军军医大学唐都医院呼吸内科2015年1月至2018年7月收治的8例侵袭性肺毛霉菌病患者的临床特征、诊治过程及预后。结果共8例患者,其中男性6例,女2例;中位年龄52岁; 7例基础疾病为糖尿病,其中4例糖尿病同时并其他疾病; 1例有长期粉尘吸入史并肺气肿。7例发病初期被误诊为细菌性肺炎、肺曲霉菌病、肺结核、肺癌等,1例首诊考虑为侵袭性肺毛霉菌病。临床症状有咳嗽7例、痰中带血4例、发热5例、气短6例;体征肺部闻及喘鸣音4例,湿啰音2例,无明显阳性体征者2例。实验室检查G试验阳性1例、GM试验阳性1例; 6例血小板及血沉明显增高。影像学表现,病变位于右肺7例、左肺1例;影像特征为渗出7例、实变2例、空洞4例、气道狭窄6例、胸腔积液4例、纵膈多发淋巴结肿大4例、肺部肿块3例、肺部单发或多发结节3例、新月征或晕轮征2例。气管镜下表现为黏膜水肿3例、肉芽组织增生4例、伪膜及坏死5例,溃疡2例、瘘道1例、气道狭窄6例、出血2例。7例经组织病理学确诊,1例经反复痰培养确诊。治疗方法药物治疗5例,手术1例,未治疗2例。预后:治愈1例,好转5例,死亡1例,无法评价1例。结论侵袭性肺毛霉菌病临床相对少见,多合并基础疾病,首诊易被误诊;病变部位以右肺多见,临床表现、影像学及支气管镜下表现缺乏特异性,确诊主要依赖于组织病理学;两性霉素B脂质体、泊沙康唑治疗效果确切,对于有大咯血高风险患者,必要时需及时外科手术。Objective To investigate the clinical characteristics,diagnosis,treatment and prognosis of patients with invasive pulmonary Mucormycosis.Method A retrospective analysis was performed on the clinical features,diagnosis,treatment process and prognosis of 8 patients diagnosed as invasive pulmonary mucormycosis at department of respiratory medicine in Tangdu Hospital,Air Force Military Medical University from January 2015 to July 2018.Result The 8 patients consisted of 6 males and 2 females,with a median age of 52 years,Among them,7 cases with diabetes mellitus as the underlying disease,4 cases with diabetes mellitus and other diseases,and 1 with a long history of dust inhalation and emphysema.7 cases were misdiagnosed as bacterial pneumonia,pulmonary aspergillosis,pulmonary tuberculosis,lung cancer and so on in the initial stage of the disease.The common clinical symptoms were cough,blood in sputum,fever,shortness of breath and wheezing.Laboratory examination showed positive G test and GM test only in 1 cases,and thrombocytopenia and erythrocyte sedimentation rate increased in 6 cases.The imaging features were exudation,cavitation,airway stenosis,pleural effusion,multiple mediastinal lymphadenopathy,lung mass,solitary or multiple pulmonary nodules,crescent sign and halo sign.Microscopic manifestation included mucosal edema,granulation tissue hyperplasia,pseudo membrane and necrosis,ulcer,fistula,airway stenosis and bleeding.7 cases were confirmed by histopathology,and 1 cases were diagnosed by repeated sputum culture.5 patients were treated with amphotericin B liposome or posaconazole,1 with surgery and 2 without treatment.Prognosis was cured in 1 cases,improvement in 5 cases,death in 1 cases,and no evaluation in 1 cases.Conclusion Invasive pulmonary mucormycosis mostly associated with underlying diseases,is relatively rare and easy to be misdiagnosed;clinical manifestations,imaging and bronchoscopic manifestations are lack of specificity,diagnosis mainly depends on histopathology;amphotericin B liposome,posaconazol

关 键 词：毛霉菌 肺 临床特征 诊断 预后 

分 类 号：R563[医药卫生—呼吸系统]