18例肺放线菌病患者和57例肺炎患者的临床分析  

Clinical analysis of 18 patients with pulmonary actinomycosis and 57 patients with pneumonia

作　　者：王敏 江子丰[2] 高锟 WANG Min;JIANG Zifeng;GAO Kun(the Second Ward of Respiratory and Critical Care Medicine Department,Anhui Chest Hospital,Hefei,Anhui 230022,China;Respiratory and Critical Care Medicine Department,Anhui Geriatric Institute,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China;the Functional Inspection Deparment,Anhui Chest Hospital,Hefei,Anhui 230022,China)

机构地区：[1]安徽省胸科医院呼吸与危重症医学科二病区,安徽合肥230022 [2]安徽医科大学第一附属医院干部呼吸与危重症医学科,安徽合肥230022 [3]安徽省胸科医院功能检查科,安徽合肥230022

出　　处：《临床肺科杂志》2024年第10期1506-1510,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽医科大学校科研基金临床科学基金项目(No.2023xkj136)。

摘　　要：目的 肺放线菌病容易误诊或延误诊断。本文回顾性分析肺放线菌病的临床特点、诊断方式和治疗及预后。方法 分析2020年1月至2024年2月安徽省胸科医院收治的18例经病理确诊的放线菌病患者的临床特征,并对比同期收集的57例肺炎(普通,非重症肺炎)患者进行对比。结果 18例肺放线菌病患者,10例为男性,8例为女性。确诊方法有支气管镜检查(n=10),胸外科手术确诊(n=6),CT引导下经皮肺穿刺术(n=2)。18例患者合并疾病排序依次为支气管扩张(n=3)、慢阻肺(n=2)、糖尿病(n=2)、肺恶性肿瘤(n=2)等。所有患者在确诊后均予以抗生素治疗,截至最后一次随访时,15例患者病情改善,1例患者失访,2例患者死亡。死亡的主要原因是肺恶性肿瘤及慢阻肺急性加重。对比对照组的57例肺炎患者,其外周血白细胞总数、中性粒细胞、单核细胞、血红蛋白、血小板、C-反应蛋白、乳酸脱氢酶、纤维蛋白原含量、D-二聚体均无显著性差异,其临床症状中,肺放线菌组中,患者出现咯血要显著高于肺炎组(61.1%vs 1.8%,P<0.001)。结论 肺放线菌感染的检验和影像学均不典型,极易误诊。咯血是肺放线菌最突出的症状,但病理学诊断依然是金标准。抗生素治疗作为首选治疗方案。Objective Pulmonary actinomycosis is easily to be misdiagnosed or delayed diagnosis.This article aims to retrospectively analyze the clinical characteristics,diagnostic methods,treatment,and prognosis of pulmonary actinomycosis.Methods The clinical characteristics of 18 patients with pathologically confirmed actinomycosis admitted to Anhui Chest Hospital from January 2020 to February 2024 were retrospectively analyzed,and they were compared with 57 patients with pneumonia(common type,non severe pneumonia)collected during the same period.Conclusion 18 patients with pulmonary actinomycosis including 10 males and 8 females were enrolled in present study.The diagnosis methods included bronchoscopy(10 cases),thoracic surgery(6 cases),and CT-guided percutaneous lung puncture(2 cases).The 18 patients were complicated with bronchiectasis(3 cases),chronic obstructive pulmonary disease(2 cases),diabetes(2 cases),and lung cancer(2 cases)and so on.All patients were treated with antibiotics after diagnosis.By the last follow-up,15 patients were improved,1 patient was lost to follow-up,and 2 patients died.The main causes of death were lung malignant tumors and acute exacerbation of chronic obstructive pulmonary disease.Compared with 57 patients with pneumonia in the control group,there was no significant differences in the total number of white blood cells,neutrophils,monocytes,hemoglobin,platelets,C-reactive protein,lactate dehydrogenase,fibrinogen content,and D-dimer in peripheral blood.In the clinical symptoms,the incidence of hemoptysis in the pulmonary actinomycosis group was significantly higher than that in the pneumonia group(61.1%vs.1.8%,P<0.001).Conclusion The examination and imaging of pulmonary actinomycetes infection are not typical,and it is easy to misdiagnose.Hemoptysis is the most prominent symptom of pulmonary actinomyces,but pathological diagnosis is still the gold standard.Antibiotic therapy is the first choice.

关 键 词：肺放线菌 临床特征 咯血 病理 

分 类 号：R519.1[医药卫生—内科学]