中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

肺放线菌病三例并文献复习

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目的探讨肺放线菌病的临床特征、诊断及治疗。方法对本院 3 例肺放线菌病及国内 65 例肺放线菌病的临床特征、诊断及治疗行回顾性分析。结果68 例患者中,男 49 例,女 19 例,年龄 6~77 岁,中位年龄 47 岁,最常见的临床表现为咳嗽、咳痰、发热,实验室检查炎性指标轻度升高,最常见的发病部位在右上肺,最典型的 CT 表现为团块中心低密度液化坏死区,伴大小不等的空洞或多个类圆形小空泡形成,即“空洞-悬浮气泡征”。正电子发射计算机断层显像显示病灶呈轻度代谢增高。68 例患者多由手术、CT 引导下经皮肺穿刺、支气管镜活检确诊。从出现症状到最终确诊平均时长 10 个月,最长甚至达 6 年 5 个月,且首诊正确率为 5.9%。41 例单纯使用抗生素治疗,15 例抗生素联合手术治疗,12 例单纯手术治疗,治愈率达 88.7%。本院诊治的 3 例患者在积极药物治疗下,症状迁延不愈。结论肺放线菌病临床特征不典型,误诊率高。当临床怀疑肺放线菌病时,应充分与微生物科沟通,确保厌氧环境下培养并延长培养周期,并积极行组织培养和病理活检明确诊断。治疗主要依靠抗生素或手术。既往报道治愈率高,但本院诊治的 3 例患者症状迁延不愈,提示部分肺放线菌病预后不乐观。

ObjectiveTo improve the knowledge of pulmonary actinomycosis.MethodsThree cases of pulmonary actinomycosis in this hospital and 65 cases reported in China were analyzed retrospectively.ResultsAmong the 68 patients 49 were male and 19 were female aged 6 to 77 years old. The most common clinical manifestations were cough, sputum and fever. Inflammatory indicators was slightly elevated. The most common site was on the right upper lung. The typical CT manifestations were the low-density liquefaction necrotic zone in the center of the mass with vacuoles of different sizes, namely, "air-space consolidation". Positron emission computed tomography showed a mild metabolic increase in lesions. The 68 patients were confirmed by surgery, CT guided percutaneous lung puncture or bronchoscopic biopsy. The average time of the diagnosis was 10 months while the longest time was 6.4 years. The rate of first diagnosis was 5.9%. Forty-one cases were treated with antibiotics alone and 12 cases were treated with simple operation, the rest were treated by antibiotics combined with surgical treatment. The cure rate was 88.7%. Although active treatment was conducted 3 patients in this hospital were not cured.ConclusionsThe clinical features of pulmonary actinomycosis are atypical and the misdiagnosis rate is high. When pulmonary actinomycosis is suspected, it should be fully communicated with the microbiologist to ensure the cultivation in anaerobic environment and extension of the incubation cycle. Tissue culture and pathological biopsy should be actively performed. Treatment depends on antibiotics or surgery with good prognosis, but for some cases the prognosis is not optimistic.

关键词: 肺放线菌病; 临床特点; 诊断; 治疗

Key words: Pulmonary actinomycosis; Clinical features; Diagnose; Therapy

引用本文: 刘婷婷, 李洪霞, 张智健. 肺放线菌病三例并文献复习. 中国呼吸与危重监护杂志, 2018, 17(6): 565-569. doi: 10.7507/1671-6205.201801050 复制

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