诺卡菌病28例临床分析  

Clinical analysis of 28 cases of nocardiosis

作　　者：吕天富 陶莉莉 朱滢 陆炳团 LYU Tianfu;TAO Lili;ZHU Ying;LU Bingtuan(Department of General Practice,the First People's Hospital of Yunnan Province,Kunming 650200,Yunnan,China)

机构地区：[1]昆明理工大学附属医院暨云南省第一人民医院全科医学科,云南昆明650200

出　　处：《右江医学》2023年第9期805-814,共10页Chinese Youjiang Medical Journal

基　　金：云南省科技厅科技计划项目(202001AY070001-300)。

摘　　要：目的分析28例诺卡菌病的临床资料,为该病的诊断和治疗提供借鉴。方法收集2015年6月至2022年9月在云南省第一人民医院确诊为诺卡菌病的住院患者,并进行回顾性总结和分析。结果28例诺卡菌病中包括14例肺部感染,9例播散性感染,4例皮肤软组织感染及1例中枢神经系统感染,其中26例患有基础疾病,主要为自身免疫性疾病和慢性肺部疾病,10例长期应用糖皮质激素,2例同时应用糖皮质激素及免疫抑制剂。通过临床标本培养确诊13例,宏基因组二代测序技术(mNGS)确诊7例,通过培养和mNGS同时确诊7例,培养和肺组织活检病理确诊1例。治疗上18例以复方磺胺甲噁唑为基础联合治疗,8例单用或联合应用抗菌药物治疗,单用磺胺类药物1例,1例住院期间未用药物治疗。合并脓胸或脓肿者充分引流。28例患者中有20例好转出院,6例患者因病情恶化和家庭经济等综合因素自动出院,2例死亡。结论培养法是临床上最常用的诺卡菌病诊断方法,但常规培养耗时较长,检出率偏低,mNGS可作为较好的替代选择。初始治疗可选择以磺胺类药物为基础的联合治疗。Objective To analyze the clinical characteristics of 28 cases of nocardiosis,so as to improve reference for the diagnosis and treatment of this disease.Methods Inpatients diagnosed with nocardiosis at the First People's Hospital of Yunnan Province from June 2015 to September 2022 were collected for retrospective summary and analysis.Results Among the 28 cases of nocardiosis,there were 14 cases of pulmonary infections,9 cases of disseminated infections,4 cases of skin and soft tissue infections,and 1 case of central nervous system infection.Among them,26 cases suffered from underlying diseases,mainly autoimmune diseases and chronic lung diseases,10 cases were treated with long-term corticosteroids,and 2 cases were treated with both corticosteroids and immunosuppressants.13 cases were confirmed by clinical specimen culture,7 cases by metagenomic second-generation sequencing(mNGS),7 cases by culture and mNGS,and 1 case by culture and lung biopsy pathology.In terms of treatment,18 cases were treated with combination therapy based on compound sulfamethoxazole,8 cases were treated with antibiotics alone or in combination,1 case was treated with sulfonamide drugs alone,and 1 case was not treated with medication during hospitalization.Patients with empyema or abscess were given complete drainage.Among the 28 patients,20 patients discharged from hospital after improvement,6 patients discharged automatically due to combination factors such as worsening condition and family economy,and 2 patients died.Conclusion Culture method is the most commonly used method for the diagnosis of nocardiosis in clinical practice,but conventional culture takes a long time and has low detection rate,so mNGS can be used as a better alternative.Sulfonamine-based combination therapy can be an option for initial treatment.

关 键 词：诺卡菌病 感染 培养 宏基因组二代测序技术 

分 类 号：R519.1[医药卫生—内科学]