【摘要】：目的:總結(jié)奴卡菌病的臨床特征,探討其早期診斷及合理治療方案,以提高臨床診治成功率。方法:報道我院收治確診的2例奴卡菌病的臨床表現(xiàn)、治療和轉(zhuǎn)歸,并以“奴卡菌病”為關(guān)鍵詞檢索維普網(wǎng)、萬方數(shù)據(jù)庫、中國知網(wǎng)數(shù)據(jù)庫(2002年12月至2016年6月),以“Nocardiosis”搜索Pub Med數(shù)據(jù)庫。結(jié)果:共檢索到國內(nèi)已發(fā)表確診為奴卡菌病病例67例。男40例,女27例;病變局限于肺40例,播散至皮膚13例,播散至腦4例,播散至心包1例,播散2個器官以上5例,肺外4例。主要危險因素為免疫抑制劑用藥史36例、肺部疾病9例、HIV6例、器官移植2例。肺部影像學(xué)主要表現(xiàn)為斑片28例、結(jié)節(jié)22例、空洞17例、胸水13例、實(shí)變11例、腫塊7例。確診通過無菌體液37例、痰培養(yǎng)16例、支氣管鏡10例、肺穿4例、活檢2例。單用磺胺治療25例,好轉(zhuǎn)17例;以磺胺為基礎(chǔ)聯(lián)合用藥治療25例,好轉(zhuǎn)14例�；前窡o效改為利奈唑胺治療5例,好轉(zhuǎn)5例。結(jié)論:奴卡菌病患者臨床表現(xiàn)缺乏特異性,無菌體液、組織送檢能提高奴卡菌診斷率。治療首選磺胺,對于免疫功能低下的患者早期主張聯(lián)合用藥,存在中樞神經(jīng)系統(tǒng)感染患者應(yīng)選利奈唑胺等血腦屏障穿透性好的藥物。早期聯(lián)合用藥、足療程使用能提高患者生存率。
[Abstract]:Objective: to summarize the clinical features of nocariasis and to explore its early diagnosis and reasonable treatment in order to improve the success rate of clinical diagnosis and treatment. Methods: the clinical manifestations, treatment and outcome of 2 cases of Nukaricosis diagnosed in our hospital were reported. China knowledge Network database (December 2002 to June 2016), search for Pub Med database with "Nocardiosis". Results: a total of 67 reported confirmed cases of Nukarycosis were found in China. The lesions were localized in the lung (n = 40), disseminated to the skin (n = 13), brain (n = 4), pericardium (n = 1), more than 2 organs (n = 5) and extrapulmonary (n = 4). The main risk factors were 36 cases of immunosuppressive drugs, 9 cases of pulmonary diseases, 6 cases of HIV and 2 cases of organ transplantation. The main imaging findings of the lung included macula in 28 cases, nodules in 22 cases, cavity in 17 cases, pleural effusion in 13 cases, consolidation in 11 cases and mass in 7 cases. 37 cases were confirmed by aseptic fluid, 16 cases by sputum culture, 10 cases by bronchoscopy, 4 cases by lung puncture and 2 cases by biopsy. 25 cases were treated with sulfanilamide alone, 17 cases were improved, 25 cases were treated with sulfanilamide and 14 cases improved. Sulfanilamide failed to be treated with linazolamide in 5 cases and improved in 5 cases. Conclusion: the clinical manifestation of the patients with Nuccariasis is lack of specificity, aseptic body fluid, tissue examination can improve the diagnosis rate of Nukarycas. Sulfanilamide is the first choice for the treatment of immunocompromised patients, and the patients with central nervous system infection should choose drugs with good penetration of blood-brain barrier, such as linazolamine. Early combined use of full course of treatment can improve the survival rate of patients.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院第一分院呼吸內(nèi)科;重慶醫(yī)科大學(xué)附屬第一醫(yī)院呼吸內(nèi)科;
【分類號】：R379.1

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