摘要
目的探讨肺毛霉病的临床特征、诊治及预后。方法回顾性分析2010年11月至2019年11月郑州大学第一附属医院收治的经组织病理确诊且资料完整的7例肺毛霉病患者的病历资料。结果7例患者中男3例,女4例,平均年龄(52.43±12.41)岁。5例有基础疾病,其中糖尿病3例,高血压1例,乙肝1例,肾移植1例。7例患者均有咳嗽、咳痰和发热症状,痰中带血6例,胸闷1例,胸痛1例。胸部CT征象:双肺多发斑片状或类结节影6例,不规则团块或软组织肿块影2例,单发或多发厚壁空洞4例,伴纵隔淋巴结肿大6例,胸腔积液3例。经支气管镜肺组织病理确诊3例,经CT引导下肺穿刺组织病理确诊4例。泊沙康唑治疗2例,均有效。两性霉素B及其脂质体联合泊沙康唑治疗2例,1例进展,1例有效。两性霉素B、两性霉素B脂质体分别联合泊沙康唑治疗1例,均有效。手术联合泊沙康唑治愈1例。结论肺毛霉病好发于有基础疾病的人群,控制基础疾病对改善预后相当重要。临床和影像学表现缺乏特异性,确诊的金标准是组织病理学检查。
Objective To investigate the clinical features,diagnosis,treatment and prognosis of pulmonary mucormycosis.Methods The medical records of 7 cases of pulmonary mucormycosis confirmed by histopathology and with complete data admitted to the First Affiliated Hospital of Zhengzhou University from November 2010 to November 2019 were analyzed retrospectively.Results There were 7 patients with pulmonary mucormycosis,including 3 males and 4 females,and the average age was(52.43±12.41)years old.Five cases had underlying diseases,including 3 cases of diabetes,1 case of residual hypertension,1 case of hepatitis B and 1 case of kidney transplantation.Seven patients all had symptoms of cough,sputum and fever.Six patients had blood in the remaining sputum,and one patient had chest tightness,and one had chest pain.Chest CT features:Six cases with multiple patchy or nodular shadows in both lungs,2 cases with irregular masses or soft tissue mass shadows,4 cases with single or multiple thick walled cavities,6 cases with mediastinal lymphadenopathy and 3 cases with pleural effusion.Three cases were diagnosed by bronchoscopy for lung histopathology,and 4 cases were diagnosed by CT guided lung puncture for histopathology.Posaconazole was effective in 2 cases.Amphotericin B and its liposome combined with posaconazole were used in 2 cases,and 1 case progressed and 1 case was effective.Amphotericin B and amphotericin B liposome combined with posaconazole respectively were effective in 1 case.One patient was cured by surgery combined with posaconazole.Conclusion Pulmonary mucormycosis is more common in people with underlying diseases.Controlling underlying diseases is very important for improving prognosis.Clinical and imaging manifestations lack specificity.The gold standard for diagnosis is histopathological examination.
作者
林蕾
王梦雨
王红民
LIN Lei;WANG Meng-yu;WANG Hong-min(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2020年第25期4638-4641,共4页
Henan Medical Research
基金
河南省科技攻关计划资助项目(172102310484)
河南省医学教育项目(wjlx2018028)。
关键词
肺毛霉病
临床特征
影像学表现
pulmonary mucormycosis
clinical features
imaging findings
