肺放线菌病30例临床特点及诊断剖析

Clinical feature analysis of 30 cases with pulmonary actinomycosis

目的总结肺放线菌病的临床特点,剖析其诊断方法。方法回顾性分析浙江大学医学院附属第一医院10年间(2007年1月一2017年11月)收治的30例肺放线菌患者的临床症状、基础疾病、影像特征、初步诊断、确诊方法、治疗及预后等特点。结果30例肺放线菌患者,年龄(59.5±7.8)岁(范围:47~81岁),病程5 d^48个月,中位病程1.5个月;18例(60.0%)合并基础疾病,10例(33.3%)有吸烟史,10例(33.3%)有嗜酒史;临床表现主要为咳嗽29例(96.7%),其次是咳痰22例(73.3%)、略血20例(66.7%)、发热12例(40.0%)、胸痛5例(16.7%)和胸闷气短3例(10.0%)。影像学可表现为团块、结节、实变、不张,病灶中可有低密度坏死灶,空洞或空泡形成。25例(83.3%)行支气管镜检查,14例镜下表现异常者中5例表现为管腔内息肉样新生物,9例表现为管腔黏膜炎性改变,其中2例存在支气管异物,1例支气管内结石。所有患者均通过病理明确诊断。经支气管镜活检明确9例(30.0%);2例(6.7%)经CT引导下经皮肺穿刺活检、18例(60.0%)经外科手术切除病灶、1例(3.3%)经胸壁肿块穿刺明确。足量足疗程青霉素治疗有效。外科手术切除病灶辅以2~4周抗生素治疗有效。结论肺放线菌病临床表现缺乏特异性,取得阳性病理标本是诊断本病的关键,首选支气管镜及经皮肺穿刺活检。

Objective To summarize the clinical characteristics of pulmonary actinomycosis andanalyze its diagnostic methods. Methods The clinical symptoms, underlying diseases, imagingcharacteristics, preliminary diagnosis, diagnostic methods, treatment and prognosis of 30 patients withpulmonary actinomycetes admitted into the First Affiliated Hospital of Zhejiang University School ofMedicine during the 10 years (January 2007 to November 2017) were retrospectively analyzed. ResultsThe 30 patients with pulmonary actinomycetes included were from 47 to 81 years old, with an average age of(59.5±7.8) years, with a course of disease from 5 days to 48 months, and a median course of disease of1.5 months;18 patients (60.0%) were complicated with underlying diseases, 10 patients (33.3%) had ahistory of smoking, 10 patients (33.3%) had a history of alcohol abuse. The main clinical manifestations werecough in 29 cases (96.7%), followed by sputum in 22 cases (73.3%), hemoptysis in 20 cases (66.7%),fever in 12 cases (40.0%), chest pain in 5 cases (16.7%) and shortness of breath in 3 cases (10.0%). Mass,nodules, consolidation, atelectasis can be seen by imaging, there can be a low-density lesion necrosis,formation of voids or vacuoles. Among the 25 patients (83.3%) who underwent bronchoscopy, 14 cases wereabnormal, 5 cases showed endotracheal polypoid neoplasms, 9 cases showed endotracheal mucosalinflammatory changes, 2 cases of them showed bronchial foreign body, and 1 case showed broncholithiasis.All cases were diagnosed by pathology. Nine cases (30.0%) were confirmed by bronchoscopic biopsy. Two cases (6.7%) underwent CT-guided percutaneous lung biopsy, 18 cases (60.0%) underwent surgical resectionof pathology, and 1 case (3.3%) was diagnosed by puncture of chest wall mass. Sufficient dose and course ofpenicillin were effective. Surgical excision of the lesion with antibiotics for 2 -4 weeks was effective.Conclusion The clinical manifestation of pulmonary actinomycosis is lack of specificity, obtaining positivepathological specimens is the key to the diagnosis of this disease, the first choice is bronchoscopy andpercutaneous lung biopsy.