川南地区某医院2014—2021年病理确诊肺真菌病77例回顾性分析  

Retrospective analysis of 77 pathologically confirmed cases of pulmonary mycosis in a hospital in the south Sichuan Basin,2014-2021

作　　者：邓佳敏 石汨鑫 熊彬 DENG Jiamin;SHI Mixin;XIONG Bin(The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院呼吸与危重症医学科,四川泸州646000

出　　处：《中国热带医学》2023年第8期875-880,共6页China Tropical Medicine

摘　　要：目的分析病理确诊肺真菌病的病原学分布、基本情况、临床表现、影像学及病理学特征、治疗方案及预后,提高肺真菌病的诊疗水平。方法收集2014—2021年西南医科大学附属医院通过病理活检确诊肺真菌病患者的临床、影像学及病理学资料并进行回顾性分析。结果经病理学确诊肺真菌病共77例,其中肺曲霉病42例(54.54%)、肺隐球菌病34例(44.16%)、肺毛霉病1例(1.30%)。77例患者中,男性38例,女性39例;年龄25~68(51.13±10.32)岁。入院时主要呼吸系统症状有咳嗽(33例,42.86%)、咯血(24例,31.17%)、咳痰(22例,28.57%)、胸痛(13例,16.88%)。胸部影像学特征主要有肺结节(37例,48.05%)、空洞影(14例,18.18%)和空气新月征(10例,12.99%)。本研究中肺真菌病患者治疗方案主要是手术切除(47例,61.04%)和抗真菌药物治疗联合手术切除(19例,24.68%),予以积极治疗后大多数(72/77,93.51%)肺真菌病患者好转出院。结论病理确诊肺真菌病以肺曲霉病和肺隐球菌病多见;入院时主要呼吸系统症状为咳嗽、咳痰、咯血;影像学特征以肺结节多见,部分肺曲霉病患者可见“空气新月征”;大多数肺真菌病治疗转归较好;真菌病理组织学特点结合过碘酸雪夫染色(PAS染色)和六胺银染色(GMS染色)等真菌特殊染色可将大部分致病真菌鉴定至属,对肺真菌病及时诊治具有重要临床意义。Objective To observe the etiological distribution,basic information,clinical characteristics,imaging and pathological features,treatment regimens,and prognosis of pathologically confirmed cases of pulmonary mycosis,aiming to improve the diagnosis and treatment level of pulmonary mycosis.Methods The clinical,imaging and pathological data of patients with pulmonary mycosis diagnosed by pathological biopsy in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2021 were retrospectively analyzed.Results There were 77 cases of pulmonary mycosis who were diagnosed by pathology,and of these patients,42 cases(54.54%)suffered from pulmonary aspergillosis,34 cases(44.16%)suffered from pulmonary cryptococcosis,and 1 case(1.30%)suffered from pulmonary mucormycosis.Among the 77 patients,there were 38 male and 39 female patients,with an age range of 25 to 68 years old(mean age 51.13±10.32 years old).The common respiratory symptoms on admission included cough(33 cases,42.86%),hemoptysis(24 cases,31.17%),expectoration(22 cases,28.57%)and chest pain(13 cases,16.88%).Chest imaging features mainly included pulmonary nodules(37 cases,48.05%),cavity(14 cases,18.18%)and air crescent sign(10 cases,12.99%).In this study,the main treatment measures for pulmonary mycosis were surgical resection(47 cases,61.04%)and antifungal therapy combined with surgical resection(19 cases,24.68%).After active treatments,most of these patients(72/77,93.51%)discharged with better condition.Conclusions Pulmonary aspergillosis and pulmonary cryptococcosis are common pulmonary mycosis diagnosed by pathology.The main respiratory symptoms on admission are cough,expectoration and hemoptysis.Pulmonary nodules are the most common imaging features,and"air crescent sign"can be seen in some patients with pulmonary aspergillosis.Most pulmonary mycosis can have good treatment outcomes.Combining fungal histopathological characteristics and fungal special staining such as Periodic Acid-Schiff(PAS)staining and Gomori methenamine silver(

关 键 词：肺真菌病 肺曲霉病 肺隐球菌病 病理 

分 类 号：R519[医药卫生—内科学]