CAJ | 학술논문

目的分析真菌性胸膜炎的临床特征.方法回顾性分析朝阳医院2005年4月至2012年12月经内科胸腔镜确诊的4例真菌性胸膜炎患者的临床资料.结果 4例患者中,男3例,女1例.年龄43 ～ 73岁.发病至确诊时间为17 d～4个月.既往体健2例,合并基础疾病2例.毛霉菌感染1例;曲霉菌感染3例,其中脓胸1例,1例合并非霍奇金淋巴瘤2年且入院后内科胸腔镜确诊淋巴瘤胸膜转移,1例合并糖尿病和低蛋白血症.主要表现:发热2例,咳嗽、咳痰3例,喘憋4例,体重减轻2例.胸部CT示胸腔积液为主,伴胸膜增厚.所有病例均有较高的血清C-反应蛋白.胸腔积液的特点:1例脓胸,另3例为渗出液,4例胸腔积液涂片及培养均未见致病菌,经胸膜病理确诊,经抗真菌及胸腔充分引流等治疗后痊愈.结论真菌性胸膜炎临床少见,胸腔积液微生物学检测阳性率低,早期胸腔镜检查非常必要.全身抗真菌并胸腔充分引流冲洗可改善预后.
목적 분석진균성흉막염적림상특정.방법 회고성분석조양의원2005년4월지2012년12월경내과흉강경학진적4례진균성흉막염환자적림상자료.결과 4례환자중,남3례,녀1례.년령43 ～ 73세.발병지학진시간위17 d～4개월.기왕체건2례,합병기출질병2례.모매균감염1례;곡매균감염3례,기중농흉1례,1례합병비곽기금림파류2년차입원후내과흉강경학진림파류흉막전이,1례합병당뇨병화저단백혈증.주요표현:발열2례,해수、해담3례,천별4례,체중감경2례.흉부CT시흉강적액위주,반흉막증후.소유병례균유교고적혈청C-반응단백.흉강적액적특점:1례농흉,령3례위삼출액,4례흉강적액도편급배양균미견치병균,경흉막병리학진,경항진균급흉강충분인류등치료후전유.결론 진균성흉막염림상소견,흉강적액미생물학검측양성솔저,조기흉강경검사비상필요.전신항진균병흉강충분인류충세가개선예후.
Objective To explore the clinical features of fungal pleurisy.Methods Four cases of fungal pleurisy diagnosed by medical thoracoscopy at Beijing Chaoyang Hospital from April 2005 to December 2012 were retrospectively studied.Results There were 3 males and 1 female with an age range of 43-73 years.The time from initial onset to definite diagnosis was 17 days to 4 months.Among them,two were previously healthy while another two had underlying diseases.The diagnoses were mucor pleuritis (n =1) and aspergillus (n =3).There was one case of empyema.One case was diagnosed as non-Hodgkin lymphoma two years ago and had pleural metastasis during hospitalization.And another one suffered concurrently from diabetes mellitus and hypoproteinemia.The primary clinical manifestations included fever (n =2),cough and sputum (n =3),breathlessness (n =4) and weight loss (n =2).The major chest computed tomography (CT) scan revealed pleural effusion with thickening.All cases had an elevated plasma level of C-reactive protein (CRP).The characteristics of pleural effusion were empyema (n =1) and exudates (n =3).Pleural fluid smear and culture tests for bacteria and fungi were negative,so were pleural fluid smear tests for mycobacteria.All cases were confirmed through histopathological examination of pleural biopsies and cured after systemic antifungal therapy and pleural irrigation.Conclusions Fungal pleurisy is infrequent.Early thoracoscopy is vital because of a low positive yield of microbiologic testing of pleural fluid specimens.Systemic antifungal therapy and pleural irrigation improve the prognosis.