CAJ | 학술논문

目的探讨中国大陆组织胞质菌病的临床特点.方法回顾分析310例国内正规期刊公开发表的组织胞质茵病的临床资料,包括临床表现、诊断、病原体类型、治疗及预后等.结果 310例患者中,男女之比接近2:1(214/96).36例合并有免疫功能受损(11.6%);高热262例(84.5%),肝和(或)脾肿大240例(77.4%),浅表淋巴结肿大86例(27.7%).234例(75.5%)经血涂片和(或)骨髓涂片确诊,尸检确诊6例,淋巴结活检和(或)肿物活检和(或)剖腹探查确诊36例;开胸肺活检确诊26例,经皮肺穿刺确诊6例,痰培养确诊2例.非洲型组织胞质菌3例,美洲型组织胞质菌307例(99.03%).播散型组织胞质菌感染269例,肺组织胞质菌病34例,其他类型7例.275例(88.7%)采用了抗真菌治疗;自动出院或死亡53例(17.1%),治愈257例(82.9%).华东和华南地区病例报告居多数.结论中国大陆以美洲型组织胞质菌感染多见;发病具有性别差异,且以免疫功能健全者居多;临床表现以高热、肝脾肿大和浅表淋巴结肿大多见;误诊率高;组织病理学方法是确诊的主要手段;抗真菌治疗效果相对较好,治疗失败率17.1%;疾病分布具有地域差异.
목적 탐토중국대륙조직포질균병적림상특점.방법 회고분석310례국내정규기간공개발표적조직포질인병적림상자료,포괄림상표현、진단、병원체류형、치료급예후등.결과 310례환자중,남녀지비접근2:1(214/96).36례합병유면역공능수손(11.6%);고열262례(84.5%),간화(혹)비종대240례(77.4%),천표림파결종대86례(27.7%).234례(75.5%)경혈도편화(혹)골수도편학진,시검학진6례,림파결활검화(혹)종물활검화(혹)부복탐사학진36례;개흉폐활검학진26례,경피폐천자학진6례,담배양학진2례.비주형조직포질균3례,미주형조직포질균307례(99.03%).파산형조직포질균감염269례,폐조직포질균병34례,기타류형7례.275례(88.7%)채용료항진균치료;자동출원혹사망53례(17.1%),치유257례(82.9%).화동화화남지구병례보고거다수.결론 중국대륙이미주형조직포질균감염다견;발병구유성별차이,차이면역공능건전자거다;림상표현이고열、간비종대화천표림파결종대다견;오진솔고;조직병이학방법시학진적주요수단;항진균치료효과상대교호,치료실패솔17.1%;질병분포구유지역차이.
Objective To explore the clinical features of histoplasmosis in China.Methods The clinical data of 310 patients of histoplasmosis were analyzed retrospectively,which were pooled from legal published periodicals.Results Ratio of male to female was about 2:1(214:96).36(11.6%)patients were immunocompromised hosts.262(84.5%)patients had hyperpyrexia.240(77.4%)patients had hepatomegaly or(and)splenomegaly.86(27.7%)patients were lymphadenectasis.Confirmed caSes made from blood smear or(and)bone marrow slides,autopsy,biopsy of lymph node or(and)exploratory laparotomy,open lung biopsy,percutaneous lung puncturation and sputum culture were 234(75.5%),6,36,26,6 and 2 respectively.307(99.03%)patients were infected by histoplasma capsulatum except 3 patients infected by histoplasma duboisii.Among the 310 patients,269 were disseminated infection,34 were pulmonary histoplasmosis,7 were other focal type.275(88.7%)patients received antifungal therapy.257(82.9%)patients were cured and 53(17.1%)patients had no response to therapy because of their severe condition.The eastern and southern areas of China were the main endemic region of histoplasmosis.Conclusion In China,histoplasma eapsulatum infection occurs more often than histoplasma duboisii.The disease has gender difference.Most of the patients are in their normal immune conditions.Hyperpyrexia,hepatomegaly,splenomegaly and lymphadenectasis are the dominant clinical manifestations.The misdiagnosis rate is high.Histopathology is the main method of diagnosis.Most patients have good response to antifungal therapy.The rate of traatment failure is 17.1%.The histoplasmosis occurs more often along the coast of southern and eastern in Chinese mainland.