新型冠状病毒感染相关性肺毛霉病的流行病学及病例分析  

Epidemiology and case analysis of COVID-19-associated pulmonary mucormycosis

作　　者：武华旭 赵伟业[2] 牟向东 曾璞 李理 王莉洁 郭文佳 贾琪 赵景全 Wu Huaxu;Zhao Weiye;Mu Xiangdong;Zeng Pu;Li Li;Wang Lijie;Guo Wenjia;Jia Qi;Zhao Jingquan(Department of Respiratory and Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Beijing 102218,China;Department of Respiratory and Critical Care Medicine,Qingdao Municipal Hospital,Qingdao 266011,China;Guangzhou Weiyuan Gene Technology Limited Company,Guangzhou 510145,China)

机构地区：[1]北京清华长庚医院呼吸与危重症医学科,北京102218 [2]青岛市市立医院呼吸与危重症医学科,青岛266011 [3]广州微远基因科技有限公司,广州510145

出　　处：《国际呼吸杂志》2024年第8期893-898,共6页International Journal of Respiration

基　　金：北京市重大疫情防治临床重点专科建设项目(XKB2022B1002);北京市医管局临床医学发展专项杨帆3.0(ZLRK202323);清华大学春风基金国内科研专项(2020Z99CFY033)。

摘　　要：目的:探究新型冠状病毒感染相关性肺毛霉病(CAPM)的流行病学并进行病例分析。方法:本研究为观察性研究。收集2022年12月9日至2023年3月9日期间经广州微远医学检验实验室送检支气管肺泡灌洗液(BALF)行宏基因组二代基因测序(mNGS)同时检测出新型冠状病毒和毛霉菌的病例的流行病学数据,并对同一时期来自于北京清华长庚医院的相关患者在流行病学、临床特征、微生物学特征、治疗及预后等方面进行回顾性分析。结果:经BALF-mNGS检测诊断新型冠状病毒感染3 001例,其中合并小孢根霉17例,米根霉16例,毛霉菌占比为1.10%(33/3 001)。北京清华长庚医院诊治新型冠状病毒感染患者846例,其中CAPM患者9例,占比为1.06%。CAPM患者中男6例,女3例;糖尿病患者6例,血液系统疾病3例,新型冠状病毒感染期间经糖皮质激素治疗4例;CAPM累及多个肺叶7例,累及单个肺叶2例。入院当日死于大咯血1例,入院当日死于呼吸衰竭1例,放弃治疗失访1例。经全身药物治疗联合支气管镜局部介入治疗4例;经全身药物治疗、支气管镜局部介入治疗联合手术治疗2例。结论:CAPM在新型冠状病毒感染患者中的总体发病率相对较低,常为糖尿病或血液系统疾病等免疫抑制宿主;CAPM病变常累及多个肺叶,全身药物治疗联合支气管镜局部介入治疗或手术治疗可取得较好的临床疗效。Objective To explore the epidemiology and case analysis of coronavirus disease 2019(COVID-19)-associated pulmonary mucormycosis(CAPM).Methods This was a observational study.Epidemiological data of bronchoalveolar lavage fluid(BALF)testing and metagenome next generation sequencing(mNGS)of patients with both COVID-19 and pulmonary mucormycosis performed in the Guangzhou Weiyuan Gene Technology Limited Company between December 9,2022,and March 9,2023 were analyzed.During the same period,CAMP cases treated in the Beijing Tsinghua Changgung Hospital were retrospectively analyzed in epidemiology,clinical features,microbiological characteristics,treatment,and prognosis.Results A total of 3001 cases of CAMP were diagnosed by mNGS plus BALF testing.Among them,there were 17 cases of Rhizopus microsporum and 16 of Rhizopus oryzae.The proportion of Aspergillus was 1.10%(33/3001).During the same period,846 patients with COVID-19 infection were treated in Beijing Tsinghua Changgung Hospital,including 9(1.06%)cases of CAPM(6 males and 3 females).Six CAMP patients had diabetes,and 3 had blood system diseases.Four CAMP patients were treated with glucocorticoid therapy during the COVID-19 infection.CAPM affected multiple lung lobes in 7 cases and a single lung lobe in 2 cases.One patient died from massive hemoptysis and another one died from respiratory failure on admission.One CAMP patient discontinued treatment and lost to follow-up.Systemic drug therapy combined with local bronchial intervention treatment was performed in 4 cases,and systemic drug therapy combined with local bronchial intervention and surgical resection of the lesion was performed in 2 cases.Conclusion The incidence of CAPM in COVID-19 patients is relatively low,with a higher occurrence in immunosuppressed individuals,such as those with diabetes or hematologic diseases.CAPM often affects multiple lung lobes.Systemic drug therapy in combination with bronchoscopy intervention or surgical treatment has shown promising clinical outcomes.

关 键 词：新型冠状病毒感染 肺毛霉病 支气管肺泡灌洗液 介入治疗 

分 类 号：R181.3[医药卫生—流行病学] R519[医药卫生—公共卫生与预防医学] R511