肺毛霉菌病的临床特征及诊断方法  

Clinical Characteristics and Diagnostic Methods of Pulmonary Mucormycosis

作　　者：陈海红[1] 谭卫平[1] 杨会敏 郭鹏豪[2] 叶子茵[3] 刘杨丽[1] 郭禹标[1] CHEN Hai-hong;TAN Wei-ping;YANG Hui-min;GUO Peng-hao;YE Zi-yin;LIU Yang-li;GUO Yu-biao(Division of Pulmonary and Critical Care Medicine,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Clinical Laboratory,The First Affiliated Hospital of Sun Yat-sen University,Guang-zhou 510080,China;Department of Pathology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院呼吸与危重症医学科,广东广州510080 [2]中山大学附属第一医院医学检验科,广东广州510080 [3]中山大学附属第一医院病理科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2023年第1期175-180,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】总结我国南方城市肺毛霉菌病(PM)的临床特征及预后,同时探讨宏基因组二代测序(mNGS)在PM诊断中的价值。【方法】回顾性分析中山大学附属第一医院2019年1月1日至2022年1月31日期间诊断为PM且曾行mNGS检测的病例,共纳入14例,确诊4例,临床诊断10例,收集其临床表现、诊治及预后资料。【结果】所有患者均有基础疾病,血液系统恶性肿瘤和糖尿病最常见。最常见的症状是发热(10例)、咳嗽(9例)和气促(9例)。胸部CT形态以实变影最多见,其次为肿块影,多伴空洞。实验室检查方面,CD4+T淋巴细胞下降、CD8+T淋巴细胞升高以及CD4+/CD8+比下降提示预后不良。CT影像学合并胸腔积液的患者预后更差。mNGS诊断的阳性率为78.5%,明显高于组织病理(50%)及肺泡灌洗液深部真菌快速荧光染色直接镜检(61.5%)、真菌培养(23.1%)。【结论】肺毛霉菌病好发于有基础疾病或免疫功能低下患者,临床表现缺乏特异性,较低的CD4/CD8比率及CT影像学合并胸腔积液的患者预后更差,mNGS诊断PM快速便捷、敏感性高,在诊断PM中具有优势。【Objective】 To summarize the clinical features and prognosis of pulmonary mucormycosis(PM) in southern China, and to explore the diagnostic value of metagenomic next generation sequencing(mNGS) in PM.【Methods】 The clinical manifestations, diagnosis, treatment and prognosis of patients diagnosed with PM in The First Affiliated Hospital of Sun Yat-sen University from January 1, 2019 to January 31, 2022 who had undergone mNGS detection in lung tissue or alveolar lavage fluid were collected retrospectively. A total of 14 patients with PM were included, including 4 patients with confirmed diagnosis and 10 patients with clinical diagnosis.【Results】 All patients had underlying medical conditions, with hematological malignancies and diabetes being the most common. The most common symptoms were fever(n = 10), cough(n = 9) and shortness of breath(n = 9). Consolidation was the most common sign of chest CT, followed by mass, mostly with cavity. On laboratory tests, decreased CD4+T lymphocytes, elevated CD8+T lymphocytes, and decreased CD4+/CD8+ ratio, and presentation with pleural effusion indicate poor prognosis. The positive rate of mNGS diagnosis was 78.5%, which was significantly higher than that of histopathology(50%), fungus rapid fluorescence staining(61.5%) and fungal culture(23.1%) of bronchoalveolar lavage fluid.【Conclusions】 Pulmonary mucormycosis is more likely to occur in patients with underlying diseases or who are immunocompromised. The clinical manifestations lack specificity. The low CD4/CD8 ratio and presentation of pleural effusion on CT imaging indicate poor prognosis of patients. mNGS is a rapid, convenient and sensitive method for the diagnosis of PM, which has advantages in the diagnosis of pulmonary mucormycosis.

关 键 词：肺毛霉菌病 临床特征 预后 诊断 宏基因组二代测序 

分 类 号：R519.8[医药卫生—内科学]