侵袭性肺真菌病误诊为支气管结核3例报道并文献复习  

Three cases of invasive pulmonary mycosis misdiagnosed as bronchial tuberculosis and literature review

作　　者：贾丽萍[1] 陈慧冬 叶媛媛[1] 王昌锋[1] Jia Liping;Chen Huidong;Ye Yuanyuan;Wang Changfeng(Department of Respiratory and Critical Care Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei,China;Department of Respiratory Interventional Medicine,Wuhan Jinyintan Hospital,Wuhan 430023,Hubei,China)

机构地区：[1]黄冈市中心医院呼吸与危重症医学科,湖北黄冈438000 [2]湖北省武汉市金银潭医院呼吸介入科,湖北武汉430023

出　　处：《中国中西医结合急救杂志》2023年第2期216-220,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖北省武汉市医药卫生科研项目(WE17B09)。

摘　　要：目的 观察气道侵袭性真菌感染的临床特点、支气管镜下表现及预后.方法 报告就诊于黄冈市中心医院确诊为肺真菌病的 3 例患者的诊治过程,展示支气管镜下表现的变化情况以直观了解气道侵袭性真菌感染与支气管结核的不同,并结合相关文献进行讨论.结果 3 例患者初诊断均考虑为支气管结核,根据病情变化情况及时调整治疗方案后均通过病理学及实验室检查明确诊断为侵袭性肺真菌病,且调整方案给予抗真菌治疗,症状缓解,病变范围得以控制.其中 1 例抗真菌治疗后再行手术治疗得以痊愈,另外 2 例抗真菌治疗后病情逐渐好转,且在持续跟踪观察中.结论 气道侵袭性真菌感染缺乏特异性的临床表现及影像学改变,且呈现出类似气管、支气管结核的镜下表现,易被误诊,只有尽早进行病理学及实验室检查以明确诊断后再给予有效治疗,才能将患者的损伤降到最低.Objective To observe the clinical characteristics,bronchoscopic manifestations,and prognosis of airway invasive fungal infection.Methods The diagnosis and treatment of 3 patients diagnosed with pulmonary mycoses in Huanggang Central Hospital were reported.The changes of bronchoscopic manifestations were shown to understand the differences between airway invasive fungal infection and bronchial tuberculosis,and the relevant literatures were discussed.Results All the 3 patients were initially diagnosed as bronchial tuberculosis,and were confirmed as invasive pulmonary mycosis by pathological examination and laboratory tests after timely adjustment of the diagnosis and treatment plan according to the changes of the condition.Antifungal treatment was given after adjustment of the plan,and the symptoms were relieved and the scope of the lesion was controlled.Among them,1 case was cured by surgical treatment after antifungal treatment,and the other 2 cases were gradually improved after antifungal treatment and were under continuous follow-up observation.Conclusions Invasive fungal infection of airway lacks specific clinical manifestations and imaging changes,and presents microscopic manifestations similar to tracheobronchial tuberculosis.So it is easy to be misdiagnosed.Only early pathological examination and laboratory tests to confirm the diagnosis and give effective treatment can minimize the trauma of patients.

关 键 词：侵袭性 肺真菌病 支气管结核 支气管镜 

分 类 号：R562.25[医药卫生—呼吸系统]