本文選題：肺部感染 + 宿主因素　； 參考：《廣西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的通過對42例確診肺曲霉菌病例宿主因素、臨床表現(xiàn)和影像學(xué)特點(diǎn)、GM試驗(yàn)、G試驗(yàn)、微生物培養(yǎng)、治療方法、死亡危險因素的統(tǒng)計(jì)分析,探討目前肺曲霉菌病臨床特點(diǎn),提高臨床醫(yī)生對肺曲霉菌病的認(rèn)知程度,以降低誤診、漏診率,為臨床診治提供依據(jù)。 方法收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院2003年1月至2012年12月出院病人診斷肺曲霉菌病病例共計(jì)213例(患者多次住院以一次統(tǒng)計(jì))、排除門診、留察肺曲霉菌病病例,選取行活體組織病理檢查的確診肺曲霉菌病病例42例,統(tǒng)計(jì)其基本情況和臨床指標(biāo)以及生存情況,然后對相關(guān)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果(1)入選42例患者全部確診,平均年齡47.1±14.5歲(16歲-65歲),男性18例(占42.85%),女性共24例(占57.14%),高發(fā)年齡段為50-59歲(占30.95%)。(2)42例確診患者寄生性為29例(占69.04%),平均年齡38.3±12.5歲(16歲-56歲),侵襲性患者13例(占30.95%),平均年齡52.7±14.3歲(32歲-65歲)。侵襲性肺曲霉菌病宿主因素以使用類固醇激素(P=0.01)、免疫抑制劑(P=0.00)、抗生素(P=0.00)多見,寄生性肺曲霉菌病肺部基礎(chǔ)疾病為宿主因素,肺結(jié)核占10.34%(P=0.03)、COPD占13.79%(P=0.03)、支氣管擴(kuò)張占13.79%(P=0.00)。(3)侵襲性肺曲霉病臨床感染癥狀較明顯,發(fā)熱(P=0.00)呼吸困難(P=0.00)、肺部Up音(P=0.00)較常見,寄生性肺曲霉菌病以咯血(P=0.00)癥狀常見。(4)侵襲性肺曲霉病以多個病灶為主(P=0.00),形態(tài)常為團(tuán)塊狀(P=0.00),病灶邊緣多不清晰(P=0.04),位置以多葉或單側(cè)雙葉為主(P=0.04)：寄生性肺曲霉病影像學(xué)病灶以孤立、單個病灶(P=0.03)居多、單肺葉(P=0.01)為主,病灶特征以新月征(P=0.01)、空洞(P=0.02)為主。(5)42例患者中寄生性肺曲霉菌病患者行GM試驗(yàn)檢查陽性者12例,陽性率為70.58%；G試驗(yàn)陽性者17例,陽性率為58.82%。侵襲性肺曲霉菌病行GM試驗(yàn)檢查陽性者6例,陽性率為75%；G試驗(yàn)陽性者8例,陽性率為62.25%。40例患者行≥2次深部痰標(biāo)本培養(yǎng),12例真菌培養(yǎng)分離出曲霉菌,陽性率30%。BALF真菌培養(yǎng)16例,分離出曲霉菌6例,陽性率37.5%。(6)42例確診患者取組織標(biāo)本行病理檢查,其鏡下可見曲霉菌絲或曲菌菌落。取活檢組織標(biāo)本部位以右肺上葉19例最多,占45%。 結(jié)論(1)近年來肺曲霉菌病發(fā)病例數(shù)有明顯增加趨勢,呼吸系統(tǒng)相關(guān)疾病占宿主因素中基礎(chǔ)疾病首位。(2)侵襲性肺曲霉病感染癥狀較明顯,寄生性肺曲霉菌病以咯血癥狀常見。(3)肺部CT影像學(xué)特征侵襲性肺曲霉病以多個病灶為主、形態(tài)常為團(tuán)塊狀、病灶邊緣多不清晰、位置以多葉或單側(cè)雙葉為主；寄生性肺曲霉病影像學(xué)病灶以孤立、單個病灶居多、單肺葉為主,病灶特征以新月征、空洞為主。(4)病灶組織病理學(xué)找到曲霉菌為確診金標(biāo)準(zhǔn),最常用取得標(biāo)本的方法是手術(shù)和氣管鏡下經(jīng)支氣管壁取肺活檢。(5)肺曲霉菌病誤診率高,確診率低(19.71%)。(6)手術(shù)+術(shù)后抗真菌藥物治療較單純抗真菌藥物治療療效較好。
[Abstract]:Objective to investigate the clinical features of pulmonary aspergillosis by means of statistical analysis of host factors, clinical manifestations and imaging features of 42 cases of pulmonary aspergillosis, including GM test G test, microbial culture, treatment methods and death risk factors. To improve the cognition of pulmonary aspergillosis in order to reduce the rate of misdiagnosis and missed diagnosis and to provide the basis for clinical diagnosis and treatment. Methods 213 cases of pulmonary aspergillosis were diagnosed in the first affiliated Hospital of Guangxi Medical University from January 2003 to December 2012. Forty-two cases of pulmonary aspergillosis diagnosed by biopsy were selected and their basic situation, clinical indexes and survival conditions were analyzed. Results 1) all 42 patients were diagnosed. The mean age was 47.1 鹵14.5 years old, 16 to 65 years old, 18 males (42.85%), 24 females (57.14%), and 29 cases (69.04%, 38.3 鹵12.5 years of age, 16 to 56 years old) in the high incidence age group of 50 to 59 years old (30.9550.59 years old), and 13 cases of invasive patients (39.04 years old, mean age 38.3 鹵12.5 years, 16 to 56 years old) and invasive patients (39.04 years old, 39.04 years old, mean age 38.3 鹵12.5 years, 16 to 56 years old) and invasive patients (13 cases). The average age was 52.7 鹵14.3 years old and 32 to 65 years old. The host factors of invasive pulmonary aspergillosis were the use of steroid hormone P0. 01, immunosuppressant P0. 00, antibiotic P0. 00. parasitic pulmonary aspergillosis was the host factor. Pulmonary tuberculosis accounted for 10.34% of the patients with COPD (13.79%), bronchiectasis 13.79%, bronchiectasis 13.79%, invasive pulmonary aspergillosis (P 0.00.P0. 00), fever P0. 00) dyspnea P0. 00m, pulmonary Up-tone P0. 00. Parasitic pulmonary aspergillosis with hemoptysis P0. 00. (4) invasive pulmonary aspergillosis mainly consists of multiple foci P0. 00G, the shape is often a lump of P0. 00P, the lesion margin is not clear, the location is multilobular or unilateral-lobed P0. 04: parasitic pulmonary aspergillosis shadow of P0. 04: parasitic pulmonary aspergillosis Imaging lesions to isolate, The main features of the lesions were crescent sign P0. 01 (P0. 02). Among the 42 patients with parasitic pulmonary aspergillosis, 12 were positive for GM test, 17 were positive for 70.58G test, and the positive rate was 58. 82B. the main results were as follows: (1) the main feature of the lesion was: crescent sign P0. 01 (P0. 01), cavitation P0. 02) among the 42 patients with parasitic pulmonary aspergillosis, the positive rate was 70.58 G test positive in 17 cases, and the positive rate was 58. 822%. In invasive pulmonary aspergillosis, 6 cases were positive for GM test, 8 cases were positive for 75 G test, and the positive rate was 62.25.40 cases were isolated from 12 cases of fungal culture by more than 2 deep sputum culture. The positive rate of fungal culture was 30%.BALF fungus culture in 16 cases. Six cases of Aspergillus were isolated and the positive rate was 37.5.The positive rate of Aspergillus or Aspergillus was detected by pathological examination in 42 cases of confirmed patients, and the mycelium or colony of Aspergillus could be found under microscope. Of the biopsy specimens, 19 cases were located in the upper lobe of the right lung, accounting for 4545%. Conclusion (1) the incidence of pulmonary aspergillosis has an obvious increasing trend in recent years, and the respiratory system disease is the first one among the host factors) the infection symptom of invasive pulmonary aspergillosis is obvious. Parasitic pulmonary aspergillosis: hemoptysis is common. 3) CT imaging features of invasive pulmonary aspergillosis are as follows: most of the lesions are mass shape, the edge of the lesion is not clear, and the location is multilobular or unilateral. The imaging lesions of parasitic pulmonary aspergillosis were isolated, with single focus, single lobe, crescent sign, cavity, histopathology finding aspergillus as the golden standard for diagnosis. The most commonly used methods for obtaining specimens were: the misdiagnosis rate of pulmonary aspergillosis was higher and the diagnosis rate was lower than 19.71%. The most common method of obtaining specimens was surgery and tracheoscopic transbronchial lung biopsy. 5) the effect of antifungal drugs after operation was better than that of simple antifungal therapy.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.1

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