18例肺毛霉菌病的临床特征与诊治分析

Clinical characteristics,diagnosis and treatment of 18 cases with pulmonary mucormycosis

目的探讨肺毛霉菌病的临床和影像特征、诊治方法和预后。方法回顾性分析四川大学华西医院呼吸内科2010年1月至2015年1月收治的18例肺毛霉菌病病例的临床特征和诊治情况。结果 18例肺毛霉菌感染病例中,男女比5∶1,年龄(54.28±17.28)岁,其中健康者仅2例,糖尿病8例,血液系统疾病3例,自身免疫性疾病2例,慢性肝、肾、肺疾病各两2例,肺腺癌1例。常见症状包括咳嗽、发热、咯血、胸痛、呼吸困难,影像学主要表现为渗出、实变、空洞、结节、团块影。12例通过组织病理确诊,1例血培养确诊,5例多次痰培养阳性临床诊断。治疗药物以两性霉素B或两性霉素B脂质体为基础。存活8例(44.4%),死亡10例(55.6%)。结论肺毛霉菌病患者临床表现无特异性,确诊主要靠组织病理检查,治疗药物仍以两性霉素B或两性霉素B脂质体为基础。

Objective To investigate the clinical and radiological characteristics,diagnosis,treatment and prognosis of patients with pulmonary mucormycosis.Methods A retrospective analysis was performed on the clinical data of 18 patients diagnosed as pulmonary mucormycosis at department of respiratory and critical care medicine in the West China Hospital,Sichuan University between January 2010 and January 2015.Results The 18 patients consisted of 15 males and 3 females with an average age of 54. 28 ±17. 28 years old.Among those cases recruited,2 were healthy subjects,8 cases with type II diabetes,3 with blood system diseases,2 with of autoimmune diseases,2 with chronic hepatic disease,2 with chronic kidney diseases,2 cases with chronic lung diseases,and 1 case with lung adenocarcinoma.Common symptoms included cough,fever,hemoptysis,chest pain and dyspnea.The image features of chest showed infiltrates,cavity,nodules,and mass by computer tomography scanning.Of the patients,12 cases were histopathologically diagnosed,5 cases through positive report of multiple sputum culture and 1 case through blood culture.Eight of 18 cases survived with the basic treatment of amphotericin B / liposomal amphotericin B.Conclusion Histopathologic diagnosis is pivotal for diagnosis.Amphotericin B / liposomal amphotericin B are the preferred drug for treatment.