结核病专科医院24例诺卡菌病临床特征分析  

Clinical analysis of 24 cases of nocardiasis in a tuberculosis hospital

作　　者：柳晓金 杨娜 程欢欢 郑立恒[1] LIU Xiao-jin;YANG Na;CHENG Huan-huan;ZHENG Li-heng(Hebei Chest Hospital,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院,河北石家庄050041

出　　处：《中国热带医学》2022年第2期177-180,共4页China Tropical Medicine

基　　金：河北省卫生健康委员会重点项目(No.20200814)。

摘　　要：目的总结结核专科病院肺诺卡菌病临床特征,为早期识别该病提供依据。方法收集并分析河北省胸科医院24例肺诺卡菌病患者临床表现、实验室检查、影像学、治疗和预后。结果24例患者,男16例,女8例,发病年龄(58.1±9.8)岁;半数以上存在肺部基础疾病,其中曾患肺结核病治愈者4例,合并活动性肺结核1例,支气管扩张症18例,艾滋病1例。常见症状为咳嗽(24例)、咳痰(24例)、发热(14例)。胸部影像学表现为胸腔积液(2例)、斑片状影(17例)、胸膜增厚(13例)、纵膈淋巴结肿大(7例)、实变(8例)和空洞(5例)。肺诺卡菌病通过痰液、肺泡灌洗液、肺组织或脓肿穿刺物中发现诺卡菌后经分子生物学方法或质谱鉴定证实。21例患者应用包含复方新诺明的联合治疗方案,3例采用复方新诺明单药治疗,治疗有效21例,1例因多种药物过敏而治疗效果不佳,2例治疗后病情持续恶化自动出院而死亡。结论结核病院肺诺卡菌病多见于结构性肺病,常规治疗无效的支气管扩张症患者要高度警惕肺诺卡菌病。Objective To summarize the clinical features of pulmonary nocardiasis in order to help clinicians identify the disease early.Methods Clinical manifestations,laboratory test results,radiological features,treatment and prognosis were analyzed in 24 patients with pulmonary nocardiasis of Hebei Chest Hospital.Results Of 24 cases,16 were males and 8 females,with mean onset age of(58.1±9.8)years.More than half of patients were accompanied with underlying pulmonary diseases including cured of pulmonary tuberculosis(4 cases),active pulmonary tuberculosis(1 case),bronchiectasis(18 cases),and AIDS(1 case).The common symptoms were cough(24 cases),expectoration(24 cases)and fever(14 cases).Chest imaging showed pleural effusion(2 cases),patchy shadow(17 cases),pleural thickening(13 cases),mediastinal lymphadenopathy(7 cases),consolidation(8 cases)and cavity(5 cases).Nocardia was found in sputum,bronchoalveolar lavage fluid,lung tissue and pus specimens which was confirmed by molecular biological method or matrix-assisted laser desorption ionization-time of flight mass spectrometry.And 21 patients were treated with combined cotrimoxazole and other antibiotics,while 3 cases were treated with cotrimoxazole only;21 cases were effective,1 case had poor therapeutic effect because of the allergy to multiple drugs and 2 cases died due to the deterioration of condition against-advice discharge.Conclusions Pulmonary nocardiosis in tuberculosis hospital is more common,especially in patients with structural pulmonary disease.It should be highly suspected in patients with bronchiectasis who are unresponsive to conventional treatment.

关 键 词：咳嗽 诺卡菌 支气管扩张症 结核病 

分 类 号：R379[医药卫生—病原生物学]