手术与未手术肺毛霉病患者29例临床特征分析

Clinical characteristics of 29 cases of pulmonary mucormycosis treated with and without surgery

目的分析接受手术治疗与未手术的肺毛霉病患者的临床特征。方法单中心回顾性研究。从中日友好医院电子病历系统中检索"肺毛霉病", 纳入 2016年7月—2022年6月的肺毛霉病患者29例, 其中男19例, 女10例, 中位年龄49(47, 67)岁。采用Mann-WhitneyU检验、χ^(2)检验、Kaplan-Meier曲线和log-rank检验比较组间差异。结果肺毛霉病患者最常见的基础疾病是糖尿病(19例, 65.5%), 影像学表现以实变(25, 86.2%)、结节或肿块(21例, 72.4%)最常见, 气管镜检查可见支气管狭窄(16例, 55.2%)、真菌菌栓阻塞支气管开口(18例, 62.1%)、支气管黏膜表面覆盖坏死物(19例, 65.5%)等异常表现。所有患者均接受抗真菌药物治疗, 13例(44.8%)患者接受手术治疗。患者是否手术由多学科团队(MDT)进行评估, 16例未手术患者中有10例为双侧多发病灶、其中4例累及主支气管而无法切除, 6例为单个肺叶内局限病灶。接受手术治疗的患者与未手术的患者相比, 单侧肺多个病灶者(6/13比1/16, P=0.019)及叶、段支气管受累者(13/13比9/16, P=0.007)更常见。15例患者行宏基因组二代测序(mNGS), 其中14例为阳性结果。进行mNGS检查缩短了从发病到诊断的时间(log-rankP=0.014)。接受手术治疗的患者院内病死率较低, 但差异无统计学意义(2/13比5/16, P=0.410)。结论 mNGS有助于肺毛霉病早期诊断。接受手术治疗患者的特征包括单侧多发病灶和支气管镜检叶、段支气管黏膜病变。

ObjectiveTo analyze the clinical characteristics of patients with pulmonary mucormycosis treated with and without surgery.MethodsThis was a single-center,retrospective study.We retrieved“pulmonary mucormycosis”from the electronic medical records of China-Japan Friendship Hospital between 2016 and 2022.A total of 29 patients with pulmonary mucormycosis were collected.There were 19 males and 10 females with a median age of 49(47,67)years.Mann-Whitney U test,χ²test,Kaplan-Meier curve and log-rank test were used to compare the differences between groups.ResultsThe most common underlying disease was diabetes(19,65.5%).The most frequent imaging findings were consolidation(25,86.2%)and nodule or mass(21,72.4%).Bronchial stenosis(16,55.2%),obstruction by fungal plugs(18,62.1%),pseudomembranous necrotizing bronchitis(19,65.5%)were common.Treatment strategies were developed by the multi-disciplinary team(MDT).Among 16 patients who did not undergo surgery,10 had bilateral multifocal lesions and 6 had unifocal lesions.All patients received antifungal therapies,and surgeries were performed in 13(44.8%)patients.Patients who underwent surgery had numerically lower in-hospital mortality(15.4%vs.31.3%,P=0.410).Involvement of unilateral multiple lesions was more common in patients who underwent surgeries(6/13 vs.1/16,P=0.019).Patients who underwent surgery were more likely to have lobar and segmental bronchial involvement(13/13 vs.9/16,P=0.007).A total of 15 patients underwent mNGS,14(93.3%)had positive results.Performing metagenomic next generation sequencing for diagnosis shortened the time from disease onset to diagnosis(log-rank P=0.014).ConclusionMetagenomic next-generation sequencing aided early diagnosis.The patients who underwent surgery included unilateral multiple lesions and visualisation of endobronchial abnormalities on lobar or segmental bronchus in unilateral lung.