分析糖尿病合并肺毛霉菌感染的临床特征  

Clinical features analysis of diabetes mellitus complicated with mucor pulmonary infection

作　　者：张润娟[1] 向永红[1] 庞宗东 张钦哲 潘海燕[1] 郑菲[1] 陈凤珍 Zhang Runjuan;Xiang Yonghong;Pang Zongdong;Zhang Qinzhe;Pan Haiyan;Zheng Fei;Chen Fengzhen(Respiratory Medicine Department,Nationality Hospital Affiliated to Guangxi Medical University,Nanning,Guangxi 530001,China)

机构地区：[1]广西医科大学附属民族医院呼吸与危重症医学科,广西南宁530001

出　　处：《齐齐哈尔医学院学报》2025年第8期743-748,共6页Journal of Qiqihar Medical University

基　　金：中国宋庆龄基金项目(2018MZFT-029)。

摘　　要：目的分析糖尿病合并肺毛霉菌感染的临床特征。方法回顾性分析本科1例2型糖尿病合并肺毛霉菌感染患者的临床资料,并复习文献。结果本科收治的1例2型糖尿病并肺部感染的患者,经BAL培养及NGS确诊为肺毛霉菌感染,该患者用两性霉素B脂质体治疗后好转出院。在Pubmed数据库获取英文文献49篇,在万方数据库和中国知网数据库获取中文文献73篇,筛选出81例经组织病理确诊或临床诊断为肺毛霉菌病合并糖尿病的病例。其中主要临床表现包括咳嗽、咳痰、发热、气促等。影像学表现主要有占位伴肺不张或阻塞性肺炎等实变病灶表现、空洞病灶、斑片状阴影等。63例经病理确诊,18例经微生物学临床诊断或确诊。54例药物治疗,好转39例,死亡15例;22例手术联合药物治疗,好转21例,死亡1例。预后再接受治疗组与未治疗组、手术联合药物治疗组与药物组比较,差异有显著统计学意义(P<0.05)。药物单用与联合差异无统计学意义(P>0.05)。结论糖尿病是肺毛霉菌病发病的独立危险因素。经皮肺穿、气管镜是临床肺毛霉菌病诊断的重要方式,手术联合药物治疗组预后更佳。Objective To analyze the clinical features of diabetes complicated with pulmonary mucor infection.Methods A retrospective analysis was carried out on clinical data of 1 case of patient with type 2 diabetes complicated with pulmonary mucor infection in our department,and the literature was reviewed.Results One patient with type 2 diabetes and pulmonary infection admitted in our department were diagnosed as pulmonary mucor infection by BAL culture and NGS.The patient was cured after amphotericin B liposome treatment.49 English papers were obtained from PubMed database and 73 Chinese papers were obtained from Wanfang database and China National Knowledge Infrastructure database.81 cases of pulmonary mucormycosis complicated with diabetes were screened out by histopathology or clinical diagnosis.The main clinical manifestations include cough,expectoration,fever,shortness of breath and so on.The imaging findings mainly included solid lesions such as space occupying with atelectasis or obstructive pneumonia,cavity lesions,patchy shadows and so on.63 cases were confirmed by pathology and 18 cases by microbiology.54 cases were treated with drugs,39 cases improved and 15 cases died;22 cases underwent surgery combined with drug treatment,21 cases improved and 1 case died.There were significant differences in the prognosis between the treated group and the untreated group,the operation combined with drug treatment group and the drug group(P<0.05).There was no significant difference between single drug group and combination group(P>0.05).Conclusions Diabetes mellitus is an independent risk factor for pulmonary mucormycosis.Percutaneous lung puncture and bronchoscopy are important methods for clinical diagnosis of pulmonary mucormycosis,and the prognosis of surgery combined with drug treatment group is better.

关 键 词：肺毛霉菌 糖尿病第二代测序 两性霉素B 脂质体两性霉素B 

分 类 号：R587.1[医药卫生—内分泌]