中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2008年
12期
1017-1021
,共5页
李华茵%朱利平%李惠萍%黄怡%周新%戎霞君%朱惠莉%何礼贤%邓伟吾%翁心华
李華茵%硃利平%李惠萍%黃怡%週新%戎霞君%硃惠莉%何禮賢%鄧偉吾%翁心華
리화인%주리평%리혜평%황이%주신%융하군%주혜리%하례현%산위오%옹심화
真菌病%整合宿主因子类%胸部影像学%诊断%治疗
真菌病%整閤宿主因子類%胸部影像學%診斷%治療
진균병%정합숙주인자류%흉부영상학%진단%치료
Mycoses%Integration host factor%Chest imaging%Diagnosis%Therapy
目的 通过分析侵袭性肺曲霉病(IPA)病例,提高IPA临床诊治水平.方法 回顾性分析49例IPA患者的人口学资料、宿主因素、基础疾病、胸部CT表现、微生物检验、组织病理学检查、治疗和转归.结果 49例IPA患者确诊19例(38.8%),临床诊断30例(61.2%).3例(6.1%)无宿主因素,与1PA相关的宿主因素和基础疾病25例(51.0%),关系不肯定的基础疾病2l例(42.9%).胸部CT表现:结节29例次,斑片影15例次,团块12例次,实变10例次,空洞34例次,晕征19例次,支气管充气征18例次,新月征6例次,双肺影33例次,多发病灶38例次.痰真菌培养阳性率为26.5%(13/49),支气管肺泡灌洗液真菌培养阳性率为66.7%(10/15),曲霉半乳甘露聚糖试验阳性率为30.6%(11/36),肺组织病理检查阳性率为90.5%(19/21).烟曲霉为主要病原菌81.0%(17/21).抗真菌药物初始治疗有效率为50%(21/42).结论 IPA患者胸部影像学表现以双肺、多发、结节影、空洞为主,晕征、新月征少见.侵袭性诊断技术具有较好的诊断价值.
目的 通過分析侵襲性肺麯黴病(IPA)病例,提高IPA臨床診治水平.方法 迴顧性分析49例IPA患者的人口學資料、宿主因素、基礎疾病、胸部CT錶現、微生物檢驗、組織病理學檢查、治療和轉歸.結果 49例IPA患者確診19例(38.8%),臨床診斷30例(61.2%).3例(6.1%)無宿主因素,與1PA相關的宿主因素和基礎疾病25例(51.0%),關繫不肯定的基礎疾病2l例(42.9%).胸部CT錶現:結節29例次,斑片影15例次,糰塊12例次,實變10例次,空洞34例次,暈徵19例次,支氣管充氣徵18例次,新月徵6例次,雙肺影33例次,多髮病竈38例次.痰真菌培養暘性率為26.5%(13/49),支氣管肺泡灌洗液真菌培養暘性率為66.7%(10/15),麯黴半乳甘露聚糖試驗暘性率為30.6%(11/36),肺組織病理檢查暘性率為90.5%(19/21).煙麯黴為主要病原菌81.0%(17/21).抗真菌藥物初始治療有效率為50%(21/42).結論 IPA患者胸部影像學錶現以雙肺、多髮、結節影、空洞為主,暈徵、新月徵少見.侵襲性診斷技術具有較好的診斷價值.
목적 통과분석침습성폐곡매병(IPA)병례,제고IPA림상진치수평.방법 회고성분석49례IPA환자적인구학자료、숙주인소、기출질병、흉부CT표현、미생물검험、조직병이학검사、치료화전귀.결과 49례IPA환자학진19례(38.8%),림상진단30례(61.2%).3례(6.1%)무숙주인소,여1PA상관적숙주인소화기출질병25례(51.0%),관계불긍정적기출질병2l례(42.9%).흉부CT표현:결절29례차,반편영15례차,단괴12례차,실변10례차,공동34례차,훈정19례차,지기관충기정18례차,신월정6례차,쌍폐영33례차,다발병조38례차.담진균배양양성솔위26.5%(13/49),지기관폐포관세액진균배양양성솔위66.7%(10/15),곡매반유감로취당시험양성솔위30.6%(11/36),폐조직병리검사양성솔위90.5%(19/21).연곡매위주요병원균81.0%(17/21).항진균약물초시치료유효솔위50%(21/42).결론 IPA환자흉부영상학표현이쌍폐、다발、결절영、공동위주,훈정、신월정소견.침습성진단기술구유교호적진단개치.
Objective studyring the proven and probable invasive pulmonary aspergillosis(IPA) eases of some hospitals in Shanghai to provide evidence fur the improvement of IPA clinical diagnosis and therapy.Methotis Fortv-nine IPA cases were retrospectively analyzed for demography data,host tactors,underlying conditions.chest CT,microorganism and histopathology examination,as well as therapy and clinical outcome.ResultsOf 49 subjects including 19(38.8%)proven and 30(61.2%)probable IPA,3 pailents(6.1%)had no host factors,25 patients(51.0%)had IPA associated host factors and underlying conditions.while 21 patients(42.9%)had uncertained fundamental diseases.Chest CT evaluation demonstrated that radiological lesions include nodules in 29 patients,patching in 15,mass in 12,consolidation in 10.cavitation in 34,Halo sign in 19,air bronchogram in 18,crescentic sign in 6,bilateral in 33 and multifocal lesions in 38.The yielding rate of fungus culture in sputum was 26.5%(13/49),and in bronchoalveolar lavage fluid was 66.7%(10/15).Eleven of thirty-six patients(30.6%)had positive results of serum galactomannan antigen tests.Nineteen of twenty-one patients(90.5%)were proven as IPA by lung histologic examinations.Aspergillus fumigatus was the most common pathogen 81.0%(17/21).The responding rate to initial anti-fugus therapy wag 50%(21/42).Conclusion Our study suggests that in IPA patients,bilateral,muhifocal and nodular lesion could be the most common radiological characteristic,while Halo and crescentic sign occar occasionally.Invasive technologies are more valuable to IPA diagnosis.
