对肺诺卡菌病患者临床治疗特点的分析研究  

Analysis of clinical characteristics of pulmonary nocardiosis infection

作　　者：许萌[1] 熊辉[1] XU Meng;XIONG Hui(Emergency Department,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院急诊科,北京100034

出　　处：《中国临床药理学杂志》2023年第16期2288-2291,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的分析肺诺卡菌病的临床特点及药物治疗情况,为临床合理有效用药提供参考。方法回顾性收集本院确诊的肺诺卡菌病患者的临床资料并进行分析,对治疗前后白细胞计数(WBC)、中性粒细胞计数(NE)、淋巴细胞计数(LY)、中性粒细胞与淋巴细胞计数比值(NLR)、C反应蛋白(CRP)、降钙素原(PCT)、体温及氧合指数的变化进行自身前后对照实验。结果18例肺诺卡菌患者中,男12例(66.67%),女6例(33.33%),中位年龄61.5岁。17例患者合并基础疾病,5例存在基础结构性肺疾病。在影像学中较常见的为新发空洞、实变和结节。最常见菌种为脓肿诺卡菌,药敏结果显示无复方磺胺甲噁唑耐药菌株。16例患者治疗过程中应用复方磺胺甲噁唑,12例患者初始应用多药联合抗感染。治疗前与治疗后患者的WBC分别为(11.83±6.95)×10^(9)·L^(-1)和(6.57±2.52)×10^(9)·L^(-1),NLR分别为26.57±31.52和4.89±4.68,CRP分别为(97.34±115.50)和(13.76±16.40)mg·L^(-1),体温分别为(38.16±1.25)和(36.54±0.26)℃,氧合指数分别为268.50±103.50和349.97±90.55。与治疗前相比,WBC、NE、LY、NLR、CRP、体温及氧合指数均较治疗前明显改善(均P<0.05)。最终18例患者均好转离院,随访显示1例因自行停药后复发。结论对可疑肺诺卡菌病感染者及时进行病原学相关检测,早期给予个体化、足疗程的抗感染治疗,密切监测可能的短期疗效评价指标变化,及时调整治疗策略,或可改善患者的预后。Objective To analyze the clinical characteristics and latest advances in diagnosis and treatment of pulmonary nocardiosis,so as to provide reference for clinical therapy.Methods A retrospective study was conducted to analyze the data of patients with pulmonary nocardiosis admitted.At the same time,the changes of white blood count(WBC),neutrophil count(NE),lymphocyte count(LY),neutrophil-lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),body temperature and oxygenation index(OI)before and after treatment were compared.Results Among the 18 patients,12 were males(66.67%)and 6 were females(33.33%),with a median age of 61.5 years.There were 17 patients with underlying disease and 5 patients with underlying structural lung disease.The clinical manifestations were not specific,and the most common imaging findings were cavities,consolidation and nodules.The most common strain was Nocardia abscessus.Result of antimicrobial susceptibility showed that no strain of nocardia was resistant to SXT.16 cases were treated with SXT.12 cases were initially given combination treatment.The WBC levels before and after treatment were(11.83±6.95)×10^(9)·L^(-1) and(6.57±2.52)×10^(9)·L^(-1),respectively;NLR levels before and after treatment were 26.57±31.52 and 4.89±4.68,respectively;CRP levels before and after treatment were(97.34±115.50)and(13.76±16.40)mg·L^(-1),respectively;body temperature levels before and after treatment were(38.16±1.25)and(36.54±0.26)℃,respectively;OI levels before and after treatment were 268.50±103.50 and 349.97±90.55,respectively.Compared with before treatment,the levels of WBC,NE,LY,NLR,body temperature and OI were significantly increased after treatment.All the 18 patients finally improved and left the hospital.Follow-up showed that 1 patient relapsed after self-withdrawal.Conclusions Timely etiological detection,early targeted and sufficient course of anti-infection treatment,close monitoring of short-term efficacy evaluation indicators,and timely adjustment of treatment strateg

关 键 词：诺卡菌病 诊断 耐药性 疗效评估 自身前后对照实验 

分 类 号：R97[医药卫生—药品]