肺诺卡菌病19例临床特点及诊疗分析  

Clinical characteristics,diagnosis and treatment of pulmonary nocardiosis:A report of 19 cases

作　　者：李凤玉 覃赞梅 杨美玲[1] 黄斯明[1] 李梅华[1] 白晶[1] 何志义[1] 邓静敏[1] Li Fengyu;Qin Zanmei;Yang Meiling;Huang Siming;Li Meihua;Bai Jing;He Zhiyi;Deng Jingmin(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Respiratory and Critical Care Medicine,Liuzhou Workers’Hospital,Liuzhou 545005,China)

机构地区：[1]广西医科大学第一附属医院呼吸与危重症医学科,南宁530021 [2]柳州市工人医院呼吸与危重症医学科,柳州545005

出　　处：《广西医科大学学报》2022年第7期1147-1152,共6页Journal of Guangxi Medical University

摘　　要：目的:探讨肺诺卡菌病(PN)的临床特征和诊疗情况,提高临床对该病的认识。方法:回顾性分析2012年1月至2020年2月在广西医科大学第一附属医院确诊的19例PN患者的临床资料,根据是否肺外累及分为单纯组(11例)和播散组(8例)。结果:19例PN患者中,年龄≥45岁16例(84.2%),症状包括发热17例,咳嗽咳痰19例,呼吸困难10例。播散组皮肤症状4例,神经系统症状2例。胸部CT表现为实变或渗出影17例,结节或肿块14例,空洞10例,胸腔积液13例。1例行全身PET/CT结果表现为SUV增高。外周血白细胞、中性粒细胞数升高17例,淋巴细胞数降低10例。C反应蛋白(CRP)、血沉均升高。两组肝肾功能损害情况比较,差异有统计学意义(P<0.05)。纤支镜下呈化脓性表现。病理表现多为慢性化脓性、炎性肉芽肿。含磺胺联合治疗14例。好转16例,恶化3例(含死亡1例,均为播散组)。结论:PN多发生于有宿主因素的中老年患者,主要表现为咳嗽咳脓痰、发热、炎症指标增高,播散者还有肺外化脓性表现,易合并肝肾功能损害;胸部CT为渗出实变影、多发结节或肿块、空洞和胸腔积液等;应尽早予含磺胺的联合方案治疗,单纯PN预后较好,播散累及脑部者预后较差。Objective:To explore the clinical features,diagnosis and treatment of pulmonary nocardiosis(PN)and improve the understanding of this disease.Methods:The clinical data of 19 patients with PN diagnosed at the First Affiliated Hospital of Guangxi Medical University from January 2012 to February 2020 were retrospectively analyzed and divided into simple(11 cases)and disseminated(8 cases)groups according to whether they had extra-pulmonary involvement.Results:Among the 19 patients with PN,16(84.2%)were aged≥45 years,and symptoms included fever in 17 cases,cough and sputum in 19 cases,and dyspnea in 10 cases.There were 4 cases of skin symptoms and 2 cases of neurological symptoms in the disseminated group.The chest CT showed solid or exudative shadow in 17 cases,nodules or masses in 14 cases,cavities in 10 cases,and pleural effusion in 13 cases.One case showed elevated SUV by whole-body PET/CT.The peripheral blood leukocyte and neutrophil counts were elevated in 17 cases,and the lymphocyte count was decreased in 10 cases;C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were elevated in all the cases.The difference was statistically significant(P<0.05)when comparing the damage of liver and kidney function between the two groups.Fiberoptic bronchoscopy showed septic manifestations.Pathological manifestations were mostly chronic purulent and inflammatory granulomas.A combination therapy containing sulfanilamide was used in 14 cases.There were 16 cases of improvement and 3 cases of deterioration(including 1 case of death,all in the disseminated group).Conclusion:PN mostly occurs in middle-aged and elderly patients with host factors.The clinical manifestations of PN are cough,purulent sputum,fever,increased inflammatory indexes,and there are extrapulmonary suppurative manifestations in disseminated PN,with a tendency to be complicated by liver and kidney impairment;chest CT shows exudative solid shadow,multiple nodules or masses,cavities and pleural effusion,etc.;treatment with a combination regimen containin

关 键 词：诺卡菌 肺诺卡菌病 临床特点 

分 类 号：R563.1[医药卫生—呼吸系统]