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中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (04) : 272 -276. doi: 10.3877/cma.j.issn.2095-655X.2016.04.015

所属专题: 文献

临床研究

肺毛霉病临床诊断学特征分析并文献复习
武薇1, 李钊2, 邵长周3,(), 姜鲁宁2, 吕高超2, 李勇4   
  1. 1. 200032 上海,复旦大学附属中山医院呼吸科;272029 济宁医学院附属医院呼吸科
    2. 272029 济宁医学院附属医院呼吸科
    3. 200032 上海,复旦大学附属中山医院呼吸科
    4. 272029 济宁医学院附属医院急诊科
  • 收稿日期:2016-07-04 出版日期:2016-11-26
  • 通信作者: 邵长周
  • 基金资助:
    上海市自然基金(13ZR1406600)

Clinical diagnostics features of pulmonary mucormycosis and literature review

Wei Wu1, Zhao Li2, Changzhou Shao3,(), Luning Jiang2, Gaochao Lyu2, Yong Li4   

  1. 1. Department of Respiratory Medicine, Zhongshan Hospital of Fudan University, Shanghai 200032, China; Department of Respiratory Medicine, Affiliated Hospital of Jining Medical University, Jining 272029, China
    2. Department of Respiratory Medicine, Affiliated Hospital of Jining Medical University, Jining 272029, China
    3. Department of Respiratory Medicine, Zhongshan Hospital of Fudan University, Shanghai 200032, China
    4. Department of Emergency, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2016-07-04 Published:2016-11-26
  • Corresponding author: Changzhou Shao
  • About author:
    Corresponding author: Shao Changzhou, Email:
引用本文:

武薇, 李钊, 邵长周, 姜鲁宁, 吕高超, 李勇. 肺毛霉病临床诊断学特征分析并文献复习[J/OL]. 中华诊断学电子杂志, 2016, 04(04): 272-276.

Wei Wu, Zhao Li, Changzhou Shao, Luning Jiang, Gaochao Lyu, Yong Li. Clinical diagnostics features of pulmonary mucormycosis and literature review[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(04): 272-276.

目的

通过分析肺毛霉病的临床症状、影像学表现、诊断、治疗和预后,提高对该病的认识。

方法

回顾性分析2007年1月至2015年12月收治的6例肺毛霉病患者的临床资料并复习国内外文献。

结果

6例均为中老年患者,病程26 d至14个月。1例无基础疾病,1例有肺结核病史,1例有慢性阻塞性肺疾病病史,1例有免疫性血小板减少症,3例有血糖升高,其中1例发病时合并有糖尿病酮症酸中毒。临床症状有咳嗽、咳痰、发热、咯血等。影像学表现:双肺团块、结节影2例,双肺多发斑片状阴影1例,单一团块病灶伴空洞2例,双肺结节伴空洞1例,胸腔积液3例,心包积液2例。6例均通过病原学或组织病理确诊,并应用两性霉素B或两性霉素B脂质体治疗,5例症状好转;1例合并有脑毛霉感染,联合应用泊沙康唑治疗,肺部症状有缓解,最终死亡。

结论

肺毛霉病临床及影像学表现缺乏特异性,通过气管镜或肺穿刺进行病原学诊断是该病的有效确诊手段。治疗的关键在于早期诊断、控制基础疾病、及时应用两性霉素B。

Objective

To enhance the recognition of pulmonary mucormycosis(PM) by analyzing the clinical symptoms, imaging features, diagnosis, treatment and prognosis of this disease.

Methods

The clinical data of 6 patients suffering from PM during January 2007 and December 2015 were retrospectively analyzed and the related literatures were reviewed.

Results

All these 6 cases were elderly patients, course of disease was 26 days to 14 months.One patient had no underlying diseases, 1 patient had pulmonary tuberculosis, 1 patient had COPD history, 1 patients had immune thrombocytopenia, 3 patients had high blood glucose and 1 of the 3 patients had diabetic ketoacidosis during development of PM.The clinical symptoms included cough, expectoration, fever, hemoptysis, etc.Imaging features showed that 2 cases had mass and nodules in double lung, 1 cases had multiple patchy shadow in double lung, single mass lesions with holes in 2 cases, double lung nodules with cavity in 1 case, pleural effusion in 3 cases, pericardial effusion in 2 cases.Amphotericin B or liposomal amphotericin B was used in all the patients for therapy, and symptoms of 5 cases improved.Posaconazole was used as combined therapy in 1 cases complicated with cerebral mucormycosis.The symptoms of the lung improved but the patients died at last.

Conclusions

The clinical and imaging features of the PM are lack of specificity.Bronchoscopy or lung biopsy is an effective method for the diagnosis of PM.Early diagnosis, control of underlying diseases, timely application of amphotericin B are the key of its treatment.

表1 6例肺毛霉菌病患者的临床资料
图1 例1肺毛霉菌病患者治疗前后胸部CT图像。图a、b 示治疗前见右肺门及气管隆突周围软组织密度影,右肺内高密度影;图c、d 示治疗1月后肺部病变较前吸收(箭头所示)
图2 例1肺毛霉病患者气管镜表现及病理学图像(HE ×40)。图a 示气管镜下右肺中间支气管管壁不规则狭窄,见结节样突起沿管壁浸润性生长;图b 示坏死组织中查见少许真菌,并少许增生上皮伴炎性渗出(箭头所示)
图3 例2肺毛霉病患者治疗前后胸部CT图像。图a、b示治疗前双肺内见多发大小不等的圆形结节、空洞,部分空洞内见软组织密度影;图c、d示治疗后空洞、结节较前吸收(箭头所示)
图4 例2肺毛霉菌病患者颅内侵袭影像学表现。图a 示CT引导下肺穿刺;图b 示MRI显示颅内多发异常信号影(箭头所示)
图5 例2肺毛霉菌病患者肺部病理学图像(HE ×200)。图a 示大部分为坏死性肉芽组织,组织细胞坏死,其中见少许真菌菌丝(HE ×40);图b 示多个随机分布的宽大无分隔或很少分隔,分支呈直角状的菌丝
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