职业性矽肺叁期合并肺结核与肺曲霉菌病1例  

Clinical analysis on a case of occupational stageⅢsilicosis combined with pulmonary tuberculosis and aspergillosis

作　　者：景华[1] 崔萍[1] 王丽[1] 刘燕[1] 李召海 于宁 张奕 李娟[1] 吴迪 赵贺 贺今 JING Hua;CUI Ping;WANG Li;LIU Yan;LI Zhaohai;YU Ning;ZHANG Yi;LI Juan;WU Di;ZHAO He;HE Jin(Shandong Academy of Occupational Health and Occupational Medicine,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan,Shandong 250002,China)

机构地区：[1]山东省职业卫生与职业病防治研究院山东第一医科大学(山东省医学科学院),山东济南250002

出　　处：《中国职业医学》2020年第4期467-469,共3页China Occupational Medicine

基　　金：山东省医药卫生科技发展计划(2017WS021)。

摘　　要：目的分析职业性矽肺合并肺结核、肺曲霉菌病的临床特点与诊断思路。方法回顾性分析1例职业性矽肺叁期合并肺结核、肺曲霉菌病患者的临床资料。结果患者临床症状为胸闷、憋喘、咳嗽、咯痰及咯血。患者于2015年在当地医院确诊为肺结核,既往2次痰涂片检查均显示结核杆菌阳性;此次入院检查患者血结核杆菌定性和痰涂片查抗酸杆菌为阴性。胸部计算机断层扫描(CT)示:右肺尘肺并大阴影,左肺下叶见密度不均匀片状影,内有低密度坏死灶,可见一空洞形成,洞壁光滑。痰真菌培养:烟曲霉+++;经支气管镜肺组织活检示:肺曲霉菌。结论职业性矽肺患者免疫力低下、营养不良,长期应用抗生素、激素,是罹患肺曲霉菌病的高危因素;辅助相应的实验室检查,结合患者临床表现与胸部CT特征性表现,综合分析病情,有助于早期诊断矽肺合并肺部曲霉菌病。Objective To analyze the clinical characteristics and diagnosis of silicosis with pulmonary tuberculosis and pulmonary aspergillosis.Methods The clinical data of a case of silicosis combined with pulmonary tuberculosis and aspergillosis was analyzed retrospectively.Results The clinical symptoms of this patient were chest tightness,suffocation,cough,expectoration and hemoptysis.The patient was diagnosed as tuberculosis in the local hospital in 2015.Two previous sputum smears of the patient were positive for mycobacterium tuberculosis.Both qualitative analysis of blood tubercle bacilli and sputum smear examination of acid-fast bacilli were negative.Chest computed tomography(CT)showed right lung pneumoconiosis with large shadow,left lower lobe of lung with uneven density and flake shadow,low density necrotic foci,a cavity with smooth wall.Sputum fungal culture:Aspergillus fumigatus(+++);bronchoscopic lung biopsy showed:Aspergillus pneumoniae.Conclusion Low immunity,malnutrition and long-term use of antibiotics and hormones are the high risk factors of pulmonary aspergillosis.It is helpful to combine laboratory examination,patients′clinical manifestations and chest CT characteristics,and to analyze the condition comprehensively for the early diagnosis of silicosis with pulmonary aspergillosis.

关 键 词：矽肺 肺结核 肺曲霉菌病 感染 并发症 临床特点 诊断 

分 类 号：R135.2[医药卫生—劳动卫生]