29例肺诺卡菌病的临床特征分析

Clinical analysis of 29 cases of pulmonary nocardiasis

目的总结肺诺卡菌病临床特征。方法分析29例肺诺卡菌病患者临床表现、影像学特征、治疗、预后。结果29例肺诺卡菌患者中,男16例,女13例,发病年龄(62.0±13.9)岁;均伴有基础疾病,其中支气管扩张症18例、2型糖尿病8例、肺结核病4例;10例使用糖皮质激素或免疫抑制剂。常见症状为咳嗽(28例)、咳痰(26例)、发热(15例)、气促(15例)等。胸部影像学表现为斑片状及结节影(24例)、胸膜增厚(17例)、胸腔积液(11例)、纵膈淋巴结肿大(10例)、实变和空洞(各9例)。24例采用复方新诺明联用其他抗生素治疗,5例用其他抗生素治疗。治疗有效26例(其中2例复发),3例放弃治疗。结论肺诺卡菌病多见于结构性肺病、免疫功能受损患者,对于常规治疗无效的支气管扩张症患者应高度怀疑肺诺卡菌病的可能。

Objective To summarize the clinical features of pulmonary nocardiasis.Methods Clinical manifestations,radiological features,treatment,and prognosis were analyzed in 29 cases of pulmonary nocardiasis.Results Of 29 cases,16 were males and 13 females,with mean onset age of 62.0±13.9 years.All patients were accompanied with underlying diseases including bronchiectasis(18 cases),type 2 diabetes(8),and tuberculosis(4),and 10 received glucocorticoids or immunosuppressive agents.Common symptoms were cough(28),expectoration(26),fever(15),and polypnea(15).Chest imaging findings included patchy and nodular shadow(24),pleural thickening(17),pleural effusion(11),mediastinal lymphadenophathy(10),consolidation(9),and cavity(9).Twenty-four patients were treated with combined cotrimoxazole and other antibiotics,while 5 with other antibiotics.Twenty-six cases were effective,with 2 relapses,and 3 gave up.Conclusion Pulmonary nocardiasis is more common in patients with structural pulmonary disease and immune impairment,and should be highly suspected in patients with bronchiectasis unresponsive to conventional treatment.