摘要
目的探讨进行性播散型组织胞浆菌病(PDH)的临床特点、诊断及治疗效果。方法回顾性分析中南大学湘雅医院诊治的PDH患者22例的临床资料。结果 PDH的临床表现主要有发热(100%,22/22),肝、脾肿大(45.5%,10/22),淋巴结肿大(68.2%,15/22),消化道症状(45.5%,10/22),呼吸系统症状(45.5%,10/22)。实验室检查示血、尿常规异常,血生化检查示白蛋白降低16例(76.2%)。入院误诊9例,诊断不明2例。9例经骨髓涂片检查确诊,13例经病理活组织检查确诊。22例患者中,19例患者给予抗真菌药物治疗,其中13例治愈,6例好转。放弃治疗2例,要求出院1例。结论 PDH临床表现复杂,通过骨髓涂片、病理组织切片进行病原学检查是确诊的依据。两性霉素、伊曲康唑、伏立康唑及氟康唑治疗有效。
Objective To review the clinical features, diagnostic and therapeutic approach of progressive disseminated histoplasmosis （PDH）. Methods The clinical data were retrospectively analyzed from 22 patients with PDH hospitalized in Xiangya Hospital, Central South University. Results PDH clinical manifestations are fever （100% , 22/22）, liver and splenomegaly （45.5%, 10/22）, lymphadenopathy （68.2%, 15/22）, gastrointestinal symptoms （45.5%, 10/22）, re- spiratory symptoms （45.5% , 10/22）. Laboratory examination revealed blood, urine abnormality, blood biochemical examination showed decreased serum albumin 16 cases （76.2%）. Hospital misdiagnosed nine eases; the diagnosis is unknown in 2 eases. 9 cases diagnosed by bone marrow smears, 13 cases of biopsy confirmed by pathology. Among 22 patients, 19 cases were treated with antifungal treatment, of which 13 cases were cured, 6 cases improved. Give up treatment in 2 cases, 1 patient required leave hospital. Conclusion PDH complex clinical manifestations, through bone marrow smears, histopathological examination is diagnosed etiology basis. Amphotericin,itraconazole, voriconazole and＇fluconazole therapy are effect for PDH.
出处
《疑难病杂志》
CAS
2013年第12期939-940,943,F0003,共4页
Chinese Journal of Difficult and Complicated Cases
关键词
组织胞浆菌病
播散型
进行性
临床特点
诊断
治疗
Histoplasmosis,disseminated,progressive
Clinical features
Diagnosis
Treatment
