肺毛霉菌病临床特征及预后分析  

Clinical features and prognosis of pulmonary mucormycosis

作　　者：白羽[1] 李雪清 郭益群[1] 杨春霞[1] 谷丽[1] Bai Yu;Li Xueqing;Guo Yiqun;Yang Chunxia;Gu Li(Department of Infectious Diseases and Clinical Microbiology,Beijing Institute of Respiratory Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Infectious Diseases,Beijing Huairou Hospital,Beijing 101400,China)

机构地区：[1]首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所感染和临床微生物科,北京100020 [2]北京怀柔医院感染疾病科,北京101400

出　　处：《首都医科大学学报》2024年第4期706-714,共9页Journal of Capital Medical University

摘　　要：目的提高对肺毛霉菌病临床特征的认识,进一步分析肺毛霉菌病患者死亡的危险因素。方法回顾性收集2017年1月至2023年6月于首都医科大学附属北京朝阳医院住院的25例肺毛霉菌病病例的易患因素、临床表现、实验室检查、影像学特征、治疗预后等资料,其中易患因素、临床表现、影像学特征及预后资料分析应用Fisher精确检验,实验室检查数据应用独立样本t检验或Mann-Whitney U检验进行分析,对差异有统计学意义的参数进行单因素回归分析,以寻找肺毛霉菌病死亡的危险因素。结果25例患者中男性15例,平均年龄(52.64±13.74)(32~76)岁,住院时间15(10.5,21.5)d,最常见的肺毛霉菌病易患因素有糖尿病(20/25)、糖皮质激素暴露(13/25)、毛霉不敏感抗真菌药物应用(10/25)和实体器官移植(5/25)。最常见的临床症状为发热(21/25)和咳嗽(21/25),其次为呼吸困难(10/25)、咯血或痰中带血(9/25)。其中死亡患者8例,与存活患者相比,死亡组患者住院时间较短(P=0.003),有实体器官移植史占比更高(P=0.023),余一般情况及易患因素在两组间差异无统计学意义。死亡组患者血小板水平低于存活组患者[174(78,227)×10^(9)/L vs 310(229,347)×10^(9)/L],两组间差异有统计学意义(P=0.030)。25例患者中最常见的毛霉目真菌为根霉属(包括少根根霉、小孢根霉等)和根毛霉属(主要为微小根毛霉)。肺内多发结节影是存活组患者更为多见的影像学改变,两组间差异有统计学意义(P=0.042)。肺毛霉菌治疗包括敏感的抗真菌药物和手术或介入治疗,存活组和死亡组患者治疗方案无明显差异。实体器官移植增加了肺毛霉菌病患者的死亡风险(OR=16.000,95%CI:1.381~185.405,P=0.027)。结论肺毛霉菌病病死率高,存在糖尿病以及糖皮质激素暴露、使用免疫抑制剂、实体器官移植等是目前较常见的易患因素,其临床表现和实验室检查大多无特异性,多�Objective To improve the understanding of the clinical characteristics of pulmonary mucormycosis and analyze the risk factors of death in patients with pulmonary mucormycosis.Methods Twenty-five cases of pulmonary mucormycosis hospitalized in Beijing Chaoyang Hospital,Capital Medical University from January 2017 to June 2023 were retrospectively collected including the risk factors,clinical manifestations,laboratory test,radiological features,treatment prognosis,etc.Among them,the risk factors,clinical manifestations,radiological features and prognosis data were analyzed by Fisher precise test.Independent sample t test or Mann-Whitney U test were used for laboratory test data.Univariate regression analysis was performed for statistically significant parameters to find risk factors for the death of pulmonary mucormycosis.Results Among the 25 patients,male accounted for 15/25,aged(52.64±13.74)(32-76)years,and the length of hospitalization was 15(10.5,21.5)days.The most common risk factors for pulmonary mucormycosis were diabetes(20/25),glucocorticoid exposure(13/25),insensitive antifungal drug use(10/25),and solid organ transplantation(5/25).The most common clinical symptoms were fever(21/25)and cough(21/25),followed by dyspnea(10/25),hemoptysis or bloody sputum(9/25).Among them,8 patients died.Compared with the surviving patients,the patients in the death group had a shorter hospital stay(P=0.003)and a higher proportion of solid organ transplantation history(P=0.023).There was no difference in other general conditions and risk factors between the two groups.Platelet levels in the death group were lower than those in the survival group[174(78,227)×10^(9)/L vs 310(229,347)×10^(9)/L],and the difference was statistically significant(P=0.030).Among the 25 patients,the most common mucor fungi were Rhizopus(including Rhizopus arrhizus,Rhizopus microsporus,etc.)and Rhizomucors(mainly Rhizomucor pusillus).Multiple pulmonary nodules were the most common imaging change in the survival group,and the difference between the

关 键 词：肺毛霉菌病 实体器官移植 预后 

分 类 号：R563.1[医药卫生—呼吸系统]