肺真菌病54例临床与病原学分析

Clinical and etiology analysis of 54 patients with pulmonary mycosis

目的探讨肺真菌病的临床表现和影像学特点、诊断和治疗,以提高对本病的认识。方法回顾性分析我院2002年1月—2008年6月经病理确诊为肺真菌病住院患者54例,总结其临床表现、影像学特点、诊断及治疗情况。结果54例患者中,肺曲霉病30例(55.6%),肺隐球菌病15例(27.8%),肺念珠菌病4例(7.4%),肺组织胞浆菌病3例(5.6%),肺孢子丝菌病1例(1.9%),放线菌肺炎1例(1.9%)。其中既往有基础疾患42例(77.8%);手术检出30例(55.6%)、纤维支气管镜下检出12例(22.2%)、CT引导下经皮肺穿刺活检检出9例(16.7%)。主要症状有咳嗽41例(75.9%)、咳痰30例(55.6%)、咯血20例(37.0%)、发热16例(29.6%);无症状者6例(11.1%)。胸部影像学表现有肿块、结节病灶41例(75.9%),团片状渗出病灶8例(14.8%),弥漫粟粒型1例,12例(22.2%)患者有空洞形成;病变累及双肺7例(13.0%),右肺26例(48.1%),左肺21例(38.9%)。54例患者中,41例门诊误诊,误诊率高达75.9%。30例(55.6%)经外科手术切除,随访1例患者术后复发隐球菌性脑膜炎,其余患者无复发。20例(37.0%)经抗真菌药物治疗,16例痊愈或显效。结论肺真菌病以肺曲霉病为多见,其次为肺隐球菌病。确诊有赖于病理学诊断。肺真菌病因病原真菌不同,获取病理组织方式、影像学表现亦有所不同,外科治疗和抗真菌药物治疗有较好的疗效。

Objective To investigate the clinical manifestations, imaging features, diagnosis and management of pulmonary my cosis. Methods Fifty-four patients were identified with pulmonary mycosis by pathological examination in our hospital from January 2002 to June 2008. Data of clinical manifestations, imaging features, diagnosis and management were retrospectively reviewed. Results Of the 54 cases, 30 （55.6%） were pulmonary aspergillosis, 15 （27.8 %） were pulmonary eryptococcosis. Underlying disease was reported in 42 of 54 （77.8%） cases. The diagnosis of all the patients was confirmed by pathological examination. Lung or bronchi tissue was obtained by operation in 30 （55.6 %） cases, by bronehofibroseope in 12 （22.2 % ） cases, by CT-guided percutaneous needle biopsy in 9 （16.7%） cases, and by lymphoid node biopsy in 4 cases. Main symptoms included cough （41, 75.9%）, expectoration （30, 55.6%）, hemoptysis （20, 37.0%）, fever （16, 29. 6%）, and asymptomatic （6, 11.1%）. The X-ray and chest CT showed masses or nodule lesions （41, 75.9%）, patchy lesions （8, 14.8%）, cavity （12, 22.2%）, diffuse milliary nodules （1 case）. Bilateral lungs were involved in 7 cases （13.0%）; right lung alone in 26 cases （48.1%）; left lung alone in 21 cases （38.9%）. Among the 54 cases, 41 （75.9%） were misdiagnosed before pathological examination. Thirty （55.6%） cases underwent surgical resection of pulmonary lesions. One patient suffered from cryptococcal meningitis after operation. Twenty （37.0%） patients received systemic anti-fugal therapy. Cure or significant improvement was found in 16 cases. Conclusions The most frequently isolated fungi were Aspergillus, followed by Cryptococcus. Final diagnosis is mainly dependent on pathological examination. Clinical manifestations, imaging features, diagnostic procedures and management are different due to the difference of pathogenic fungi. Satisfactory results can be obtained by anti-fungal therapy combined with surgical management.