肺奴卡菌病16例临床分析  

Clinical features of pulmonary nocardiosis:A case series of 16 patients

作　　者：王传海 扈晓静 张建[1] 李霜[1] WANG Chuanhai;HU Xiaojing;ZHANG Jian;LI Shuang(Department of Respiratory and Critical Care Medicine,Shengli Oilfield Central Hospital,Dongying 257034,Shandong Province,China)

机构地区：[1]胜利油田中心医院呼吸与危重症医学科,山东东营257034

出　　处：《解放军医学院学报》2022年第11期1151-1155,共5页Academic Journal of Chinese PLA Medical School

摘　　要：背景奴卡菌是一种条件致病菌,肺是最常受累的器官,但肺奴卡菌病的临床症状和影像学特征不具有特异性,容易漏诊和误诊。目的探讨肺奴卡菌病的临床特点、影像学表现、治疗情况及预后。方法回顾性分析我院2017年1月-2021年12月确诊为肺奴卡菌病患者的临床资料。结果共诊治16例肺奴卡菌病患者,男6例,女10例,年龄43~87岁,6例合并自身免疫性疾病并长期口服糖皮质激素,10例合并慢性结构性肺病;临床症状主要表现为咳嗽咳痰15例(93.7%)、发热12例(75.0%)、呼吸困难12例(75.0%);影像学主要表现为结节/肿块影(87.5%)、伴空洞(50.0%)、多发斑片影(62.5%)、实变(37.5%),其他表现为胸膜增厚、纵隔淋巴结肿大、胸腔积液、支气管扩张等。16例多数白细胞计数、中性粒细胞比例、C反应蛋白升高,降钙素原正常或轻度升高(≤0.5 ng/mL)者占62.5%(10/16),明显升高者(>0.5 ng/mL)仅占37.5%(6/16)。通过痰培养、肺泡灌洗液培养等方法对奴卡菌感染进行诊断。治疗以磺胺类药物为基础单药或联合为主,大多预后良好。结论肺奴卡菌病常见于免疫抑制宿主或慢性结构性肺病患者,临床表现和影像学特征无特异性。对有易感因素人群,常规抗感染效果欠佳时要想到该病可能,早期识别鉴定菌种和及时针对性抗感染治疗对改善预后意义重大。Background Nocardia is an opportunistic pathogen with lung as the most frequently involved organ.However,the clinical symptoms and imaging features of pulmonary nocardiosis are not specific,so it is easy to be misdiagnosed or miss diagnosed.Objective To investigate the clinical features,imaging manifestations,treatment and prognosis of pulmonary nocardiosis.Methods Clinical data about patients diagnosed with pulmonary nocardiosis in Shengli Oilfield Hospital from January 2017 to December 2021 were collected and analyzed retrospectively.Results There were 16 patients with pulmonary nocardiosis,including 6 males and 10 females,aged 43-87 years old,6 cases were combined with autoimmune diseases receiving long-term oral glucocorticoid,and 10 cases with chronic structural lung diseases;Among 16 patients,cough and sputum was found in 15 cases(93.7%),fever in 12 cases(75.0%),and dyspnea in 12 cases(75.0%);Nodule or mass(14/16),with cavities(8/16),multiple plaque shadow(10/16),consolidation(6/16)were the major imaging manifestations,and others including pleural thickening,mediastinal lymph node enlargement,bronchiectasis,pleural effusion were also seen in some patients.White blood cell count,neutrophil ratio and C reaction protein were elevated in most of the patients.Normal or mildly elevated calcitoninogen(≤0.5 ng/mL)were seen in 10 cases(62.5%),while significant elevated calcitoninogen(>0.5 ng/mL)in 6 cases(37.5%).The diagnosis of nocardia infection was made by sputum culture and alveolar lavage fluid culture,and its treatment was based on sulfonamide therapy with good prognosis achieved in most cases.Conclusion For immunosuppressed hosts or patients with chronic structural lung diseases,when empirical anti-infection treatment fails,we should consider the possibility of pulmonary nocardiosis.Early access to pathogenic results and timely anti-infection treatment are of great significance to improve prognosis.

关 键 词：肺奴卡菌病 临床特征 诊断 治疗 预后 

分 类 号：R563.1[医药卫生—呼吸系统]