24例肺真菌病回顾性分析

Retrospective analysis of 24cases of pneumomycosis

目的了解肺真菌病的流行病学特点、宿主因素、影像学特征、诊断、治疗和预后。方法回顾性分析中南大学湘雅医院2011年12月—2014年11月24例确诊肺真菌病住院患者的临床资料。结果 24例患者中,肺曲霉病11例(45.8%),肺隐球菌病8例(33.3%),肺组织胞浆菌病3例(12.5%),肺毛霉病1例(4.2%),放线菌病1例(4.2%)。24例肺真菌病患者中,存在基础疾病的高达66.7%,基础疾病主要为慢性阻塞性肺疾病、肺结核和糖尿病等。肺真菌病的临床症状以咳嗽最常见,占83.3%,其次是咯血或痰中带血(62.5%)多见,但不具有特异性。最常见的危险因素为长期使用广谱抗菌药物及低蛋白血症。肺部影像学表现多种多样,"晕征"对肺曲霉病的诊断有一定价值。而胸膜下孤立性结节或肿块,对肺隐球菌的诊断有一定意义。24例肺真菌病中,9例由手术或抗真菌药物联合手术治疗,获得痊愈;14例经抗真菌药物治疗,其中痊愈1例、好转12例、死亡1例;1例拒绝任何治疗。结论临床医师应对肺真菌病的危险因素、宿主因素、临床表现以及病原学综合分析,进行病理组织学检查可确诊,并提高诊断率,选择合适的治疗方式,提高治愈率。

Objective To review the epidemiological,radiologic and clinical characteristics of pneumomycosis for improving diagnosis,treatment and prognosis.Methods Twenty-four cases of pneumomycosis treated in Xiangya Hospital of Central South University from December 2011 to November 2014 were reviewed and analyzed retrospectively.Results The 24 cases of pneumomycosis included 11（45.8 %）cases of pulmonary aspergillosis,8（33.3 %）cases of pulmonary cryptococcosis,3（12.5%）cases of pulmonary histoplasmosis,1（4.2%）case of pulmonary mucormycosis,and 1（4.2%）case of pulmonary actinomycosis.Underlying disease was found in 66.7%（16/24）of the 24 patients,primarily chronic obstructive pulmonary disease,pulmonary tuberculosis,and diabetes mellitus.The symptoms are non-specific.Cough is the most frequently documented clinical symptom of pneumomycosis（83.3% patients）,followed by hemoptysis or bloody sputum（62.5%）.The most common risk factor is long-term use of broad-spectrum antibiotic and hypoproteinemia.The signs of pulmonary imaging are variable. ＂ Halo sign＂ is helpful for diagnosis of pulmonary aspergillosis.Subpleural solitary nodules or masses are indicative of pulmonary cryptococcosis.Nine of the 24 pneumomycosis patients were cured by surgery or surgery plus antifungal drugs.One patient refused any treatment.And the remaining 14 patients were treated with antifungal agents,resulted in cure in 1 case,improvement in 12 cases,and 1 death.Conclusions Clinicians should analyze the risk factors,host factors,clinical manifestations and etiology of pneumomycosis in a comprehensive way,actively seek for histopathologic examination,choose appropriate treatment approach so as to improve cure rate.