【摘要】：目的：原發(fā)性肺曲菌病,在臨床上比繼發(fā)性肺曲菌病要少見得多,起病較隱匿,易被臨床醫(yī)師忽視。本文就原發(fā)性肺曲菌病臨床資料進行分析,以進一步提高對此病的認識,減少漏診、誤診。 方法：2000年1月至2011年12月在廣西醫(yī)科大學第一附屬醫(yī)院住院且經(jīng)組織病理學確診的9例原發(fā)性肺曲菌病患者的臨床資料進行回顧性分析,分析其臨床、影像學、病理學表現(xiàn)及實驗室檢查、治療情況并結(jié)合國內(nèi)外文獻進行討論。 結(jié)果：9例患者既往體健均無基礎(chǔ)疾病史,免疫功能正常,無長期糖皮質(zhì)激素、免疫抑制劑、抗生素使用史。9例均經(jīng)組織病理學確診。①女性5例,男性4例,年齡29-58歲,平均年齡(42±10)歲。②職業(yè)：農(nóng)民7例(7/9)其中4例有較明確霉變、陳舊物品接觸史,工人2例(2/9)。③臨床特征：咯血8例(8/9),小量咯血3例,1-10mL/次不等,大咯血5例,最多可達200mL/次�？人浴⒖忍�8例(8/9),發(fā)熱1例(1/9)最高體溫達40℃,盜汗2例(2/9)。1例病變部位(左上肺)可聞及少許濕性Up音,余體格檢查無特殊。④影像學：空洞7例,空洞內(nèi)結(jié)節(jié)腫塊影7例,“新月征”6例,小結(jié)節(jié)影1例,腫塊影2例。病變部位：病變部位以上葉尖后段、下葉背段為主,病變可涉及多肺段多肺葉。增強后病灶均無強化。⑤實驗室及器械檢查：血常規(guī)、肝腎功能、腫瘤標記物正常。9例痰涂片找真菌、痰真菌培養(yǎng)(-)。9例肺功能檢查正常,6例支氣管鏡示病灶處氣管、支氣管粘膜充血、水腫,9例患者中1例行血清真菌毒素葡聚糖總含量960.5pg/ml(參考值0-10)。⑥治療：6例患者長期誤診為肺結(jié)核,最長達10余年,長期反復服用抗結(jié)核治療,3例誤診肺癌,入院后6例行外科病灶切除術(shù),其中兩例術(shù)后聯(lián)合伏立康唑、伊曲康唑、兩性霉素B抗真菌治療,3例單獨行抗真菌治療。⑦轉(zhuǎn)歸：5例術(shù)后治愈,其中1例術(shù)后因病灶未完全切除而再次行手術(shù)治療治愈；1例術(shù)后聯(lián)合抗真菌治療好轉(zhuǎn)；3例單一經(jīng)抗真菌治療后病情緩解,無死亡病例。 結(jié)論：1原發(fā)性肺曲菌病患者有重要的霉變陳舊物品吸入/接觸史。 2原發(fā)性肺曲菌病起病多隱匿,慢性過程,進展相對緩慢。 3最常見的臨床癥狀為咯血、咳嗽,發(fā)熱等全身癥狀少見。 4影像學上以空洞、“新月征”、孤立腫塊影為常見,發(fā)病部位以上葉尖后段、下葉背段為多見。 5纖支鏡下管腔多受累,肺功能正常,氣道反應(yīng)性不高。 6病灶組織病理學找到曲菌絲即可確診,手術(shù)和TBLB是最常用且有效的取得標本的方法。 7常誤診肺結(jié)核、肺癌。 8手術(shù)/抗真菌治療療效較好。
[Abstract]:Objective: primary pulmonary aspergillosis is much less common than secondary pulmonary aspergillosis in clinic. The clinical data of primary pulmonary aspergillosis were analyzed in order to further improve the understanding of the disease and reduce missed diagnosis and misdiagnosis. Methods: the clinical data of 9 patients with primary pulmonary aspergillosis who were hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2000 to December 2011 and confirmed by histopathology were analyzed retrospectively. Pathological findings, laboratory examination, treatment and the literature at home and abroad were discussed. Results 9 cases had no history of basic disease, normal immune function, no long-term glucocorticoid, immunosuppressant, antibiotic use history of 9 cases confirmed by histopathology in 5 cases, male 4 cases, age 29-58 years. The average age was (42 鹵10) years 2 occupation: 7 cases (7 / 9) of peasants had definite mildew, 4 cases had a history of contact with obsolete materials, 2 cases (2 / 9) of workers had clinical characteristics: 8 cases (8 / 9) of hemoptysis, 3 cases of small volume hemoptysis ranged from 1-10 mL / time, 5 cases of massive hemoptysis, up to 200mL/ times. There were 8 cases of cough and expectoration (8 / 9), 1 case of fever (1 / 9) with the highest body temperature up to 40 鈩，

本文編號：2139807