肺诺卡菌病25例临床特征分析  

Clinical features of 25 cases of pulmonary nocardiosis

作　　者：毛雅云[1] 陈磊[1] 翁恒[1] MAO Yayun;CHEN Lei;WENG Heng(Department of Respiratory and Critical Care Medicine,Fuzhou Pulmonary Hospital affiliated to Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属福建省福州肺科医院呼吸与危重症医学科,福州350001

出　　处：《中国感染与化疗杂志》2020年第6期613-617,共5页Chinese Journal of Infection and Chemotherapy

基　　金：福建省级临床重点专科建设项目-呼吸内科[闽卫医政函(2018)145号]。

摘　　要：目的探讨肺诺卡菌病的临床特征、影像学表现及诊断、治疗情况,为早期识别该病提供依据.方法收集并分析福州肺科医院2002-2019年确诊为肺诺卡菌病患者的临床资料.结果共收集到25例患者,有半数以上患有肺部基础疾病,包括支气管扩张症、慢性阻塞性肺疾病、肺间质纤维化及尘肺、陈旧性肺结核等,12例不伴有肺部基础病但其中3例有全身免疫抑制病史.7例无任何基础疾病.常见症状为咳嗽、咯黄脓痰、发热.伴随血白细胞计数、中性粒细比例、C反应蛋白和降钙素原明显升高.胸部CT表现多为双肺弥漫性改变,大片实变影是最常见表现(15/24),其他可见支气管充气征(11/24)、空洞形成(15/24);25例均现胸腔积液,部分可见纵隔淋巴结明显增大.容易经痰或支气管肺泡灌洗液培养确诊(痰9例,支气管肺泡灌洗液7例),播散性病例可经血培养确诊(3例),1例淋巴结活检组织培养确诊.1例治疗过程中自动出院,1例治疗后恶化自动出院死亡,1例未经治疗死亡,其余22例均好转出院.结论肺诺卡菌病常见的临床表现为化脓性细菌感染,包括咳嗽、咯黄脓痰、发热.伴随血C反应蛋白、降钙素原、白细胞计数及中性粒细胞比例明显升高.胸部CT表现大片实变影,可见支气管充气征、肺空洞.痰或病变组织培养阳性率高,早期使用足量、足疗程有效抗菌药物治疗,预后较好.Objective To examine the clinical features,imaging signs,diagnosis,and treatment of pulmonary nocardiosis and to provide evidence for early clinical management of the patients.Methods A retrospective analysis was conducted with the clinical data of the patients with pulmonary nocardiosis who were treated in Fuzhou Pulmonary Hospital during the period from 2002 to 2019.Results More than half of the 25 patients had underlying lung disease,including bronchiectasia,chronic obstructive pulmonary disease,interstitial pulmonary fibrosis,pneumoconiosis,and old pulmonary tuberculosis.12 patients did not have underlying lung disease,but 3 of these patients had a history of treatment with systemic immunosuppressants.Seven patients did not have any underlying disease.The common symptoms were cough,yellow purulent sputum,and fever.Serum C-reactive protein,procalcitonin,WBC count,and neutrophils percentage increased significantly.Most of the chest CT findings were bilateral lung diffuse lesion.Large consolidation opacity was the most common CT manifestation(15/24).Air bronchogram sign(11/24)and cavities(15/24)could be seen in most cases.Pleural effusion was found in all cases.Some mediastinal lymph nodes were significantly enlarged.Various specimens were used for microbiological diagnosis of pulmonary nocardiosis,including sputum(9 cases),bronchoalveolar lavage fluid(7 cases),blood culture(3 cases),and lymph node biopsy(1 case).One patient left hospital voluntarily without follow-up.Another patient died due to disease deterioration.One patient died before diagnosis without treatment.The remaining 22 patients showed improvement before discharge from hospital.Conclusions The clinical manifestations of pulmonary nocardiosis are consistent with suppurative inflammatory changes,including cough,yellow purulent sputum,and fever.Serum C-reactive protein,procalcitonin,WBC count,and neutrophils percentage increase significantly.Chest CT showed extensive consolidation,air bronchogram sign,and cavitation.Sputum or lesion tissue is useful

关 键 词：肺诺卡菌病 免疫抑制 脑脓肿 

分 类 号：R519.1[医药卫生—内科学]