病理确诊肺真菌病43例临床特征分析

Analysis of clinical characteristics of 43 patients with pulmonary mycosis diagnosed by pathology

目的分析病理确诊肺真菌病患者的病原学分布、临床表现和影像学改变等临床特征。方法收集2018年1月至2020年7月济宁医学院附属医院经外科手术、支气管镜或经皮肺穿刺病理确诊的肺真菌病患者临床资料,回顾性分析其病原学分布、临床表现和影像学改变。结果入选经病理学确诊肺真菌病患者43例,分别经外科手术确诊26例(60.47%),经支气管镜确诊14例(32.56%),经皮肺穿刺确诊3例(6.98%);肺曲霉病27例(62.79%),肺隐球菌病11例(25.58%),肺念珠菌病3例(6.98%),肺毛霉病2例(4.65%)。43例患者中27例(62.79%)存在真菌感染危险因素:糖尿病10例(23.26%),恶性肿瘤7例(16.28%),支气管扩张症4例(9.30%),乙型肝炎病毒携带3例(6.98%),长期应用糖皮质激素2例(4.65%),肺结核2例(4.65%),结肠癌术后化疗1例(2.33%)。43例患者主要呼吸系统症状:咳嗽24例(55.81%),咳痰21例(48.84%),咯血16例(37.21%),发热9例(20.93%),喘息8例(18.60%),胸痛7例(16.28%),声音嘶哑1例。胸部影像学改变:肺部结节20例(46.51%),"血管贴边征"12例(27.91%),斑片渗出影10例(23.26%),团块/实变8例(18.60%),空洞7例(16.28%),管壁增厚并管腔狭窄6例(13.95%),空气新月征5例(11.63%)。结论肺真菌病以肺曲霉病和肺隐球菌病为多见;常见基础疾病为糖尿病及恶性肿瘤;主要临床表现为咳嗽、咳痰及咯血;影像学表现主要以肺部结节多见,肺隐球菌病可见"血管贴边征"。

Objective To observe the etiological distribution,clinical presentations and imaging features of pulmonary mycosis that is diagnosed by pathology.Methods The etiological distribution,clinical presentations and imaging features of patients with pulmonary mycosis,who were collected in the Affiliated Hospital of Jining Medical University from January 2018 to July 2020,were retrospectively analyzed.The diagnosis of all the patients were confirmed by pathological examination,of lung or bronchi tissue that were obtained through operation,bronchoscope or percutaneous lung puncture biopsy.Results There were 26 patients'(60.47%,26/43)pathological specimens were obtained by operation,14 cases(32.56%,14/43)were obtained by bronchoscope,and 3 cases(6.98%,3/43)were obtained by percutaneous lung puncture biopsy.Of the 43 patients who were diagnosed pulmonary mycosis by pathology,27 patients(62.79%,27/43)suffered from pulmonary aspergillosis,11 patients(25.58%,11/43)suffered from pulmonary cryptococcosis,3 patients(6.98%,3/43)suffered from pulmonary mucormycosis,and 2 patients(4.65%,2/43)suffered from pulmonary candidiasis.There were 27 patients(62.79%,27/43)with pulmonary fungal disease complicating risk factors of fungal infection,including diabetes mellitus(23.26%,10/43),malignant tumor(16.28%,7/43),bronchiectasis(9.30%,4/43),hepatitis B virus(HBV)carrier(6.98%,3/43),taking glucocorticoids(4.65%,2/43),pulmonary tuberculosis(4.65%,2/43),and chemotherapy following colon carcinoma operation(2.33%,1/43).The common clinical presentations included cough(55.81%,24/43),expectoration(48.84%,21/43),hemoptysis(37.21%,16/43),fever(20.93%,9/43),gasping(18.60%,8/43),chest pain(16.28%,7/43),and hoarseness(3.13%,1/43).Imaging features of chest included lung nodes in 20 cases(46.51%,20/43),vascular welt sign in 12 cases(27.91%,12/43),exudative process in 10 cases(23.26%,10/43),lung mass or consolidation in 8 cases(18.60%,8/43),cavitary lesions in 7 cases(16.28%,7/43),thicken bronchus wall and narrow lumina in 6 cases(13.95%,6/43),air crescent in 5 cases(11.63%,5/43).Conclusions The pulmonary aspergillosis and cryptococcosis are mainly in pulmonary mycosis diagnosed by pathology.The common complications are diabetes mellitus and malignant tumor.The common clinical presentations are cough,expectoration,and hemoptysis.The main imaging features of chest are lung nodes and vascular welt sign can be found in most of pulmonary cryptococcosis.