肺放线菌病一例并文献复习  

Pulmonary actinomycosis: a case report and literature review

作　　者：张丽艳 邵艳梅[2] 程兆忠[2] 张雪娟[1] Zhang Liyan;Shao Yanmei;Cheng Zhaozhong;Zhang Xuejuann(Department of General Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院全科医学科,266000 [2]青岛大学附属医院呼吸与危重医学科,266000

出　　处：《国际呼吸杂志》2020年第10期762-766,共5页International Journal of Respiration

摘　　要：目的提高临床医师对肺放线菌病的认识,强调及早获取组织病理学证据(如支气管镜下活检)对肺放线菌病的诊断意义。方法报道1例支气管镜下肺盲检诊断的肺放线菌病。以"肺放线菌病"为检索式检索中国知网数据库;检索时间从2000年1月至2019年6月。结果共检索到196篇文献,筛选其中具有比较完整临床资料的国内个案54例,加上本文报道的1例,共55例。男39例(70.9%)、女16例(29.1%),男女比例约为2.4∶1,年龄范围为20~77岁,临床多表现为咳嗽、咳痰、痰中带血、发热、胸痛等,多累及单肺叶,影像学无特异表现,初诊误诊率高达74.5%,可通过支气管镜检查、肺活检明确诊断。大剂量青霉素冲击治疗为目前首选方案。55例患者的治愈率为75.6%,较既往报道有所下降。结论肺放线菌病临床罕见,临床表现、实验室检查无明显特异性,误诊率极高,确诊主要依靠组织病理学证据,早期确诊有利于患者恢复。二十一世纪治愈率下降可能与机体耐药相关。Objective To improve clinicians′understanding of pulmonary actinomycosis and emphasize the early diagnosis of histopathological evidence(such as bronchoscopic biopsy)for pulmonary actinomycosis.Methods A case of pulmonary actinomycosis diagnosed by pulmonary blind examination under bronchoscope was reported."Pulmonary actinomycosis"was used as a searching method to retrieve CNKI database from January 2000 to June 2019.Results A total of 196 articles were retrieved and 54 domestic cases with relatively complete clinical data were screened,added the case reported in this article,a total of 55 cases were reported in this paper.There were 39 males(70.9%)and 16 females(29.1%),male to female ratio was about 2.4∶1,and the age range was 20-77 years old.Clinical manifestations are cough,sputum,phlegm with blood,fever,chest pain,etc.,accumulating single lung lobe,no specific imaging manifestations,the misdiagnosis rate of initial diagnosis as high as 74.5%,which can be confirmed by bronchoscopyand lung biopsy.High-dose penicillin shock therapy is the preferred treatment at present.The cure rate of 55 patients was 75.6%,which was lower than that reported before.Conclusions Actinomycosis is rare in clinic and has no obvious specificity in clinical manifestation and laboratory examination.The rate of misdiagnosis is very high.The diagnosis mainly depends on histopathological evidence.Early diagnosis is beneficial to the recovery of patients.The decrease of cure rate may be related to drug resistance in the 21st century.

关 键 词：放线菌病 支气管镜 早期诊断 治疗 

分 类 号：R51[医药卫生—内科学]