摘要
目的通过分析肺毛霉病的临床表现、影像学特点、诊断、治疗及预后，提高对该病的诊治水平。方法分析8例经肺组织活检病理确诊且有完整资料的肺毛霉病病例资料。结果8例肺毛霉病患者男6例（包括1例新生儿，35周早产），女2例，中位年龄51．5岁（36d-66岁）。合并糖尿病者4例，肾移植术后者3例，接受糖皮质激素治疗者2例。胸部影像学表现：多发不规则团块或结节影3例，多发厚壁型空洞影3例，双肺弥漫性浸润影1例，双肺实变影1例。经皮肺穿刺活检确诊7例，经纤维支气管镜活检确诊1例。手术联合两性霉素B脂质体（60mg/d，疗程3周）治疗l例，痊愈，随访1年10个月，无复发；两性霉素B脂质体治疗3例（新生儿7mg/d，疗程62d；l例60mg/d，疗程31d；l例70mg/d，疗程71d），显效出院，随访8个月-2年5个月，1例复发死亡。伊曲康唑（400-200mg/d，疗程21d-1年）治疗3例，随防1个月-1年8个月，2例复发，1例死亡。8例患者中2例死于毛霉感染。结论肺毛霉病诊治困难，病死率高；可疑病例应及时行经皮肺穿刺等组织活检术；可选用两性霉素B脂质体或伊曲康唑抗毛霉治疗；及时控制导致毛霉病的病因是改善预后、减少复发的关键。
Objective To improve the understanding of pulmonary mucormycosis by analyzing the clinical manifestations, imaging features, diagnosis, treatment and prognosis of this disease. Methods The clinical data of eight patients diagnosed as pulmonary mucormycosis by histopathologic examination were retrospectively analyzed. Results Eight patients included six males and two females with age from 36 days to 66 years. Underlying conditions covered diabetes （ n = 4）, renal transplantation （ n = 3 ）, premature （ n = 1 ） and long-term corticosteroid treatment in two cases. Imaging manifestations revealed multiple irregular lumps or nodules in three cases, multiple cavities with thick wall in three cases, diffuse lung infiltrate in one case and lung opacities in one case. The diagnoses of seven patients were confirmed by percutaneous needle lung biopsy and the remaining one was diagnosed with fiberoptic bronchoscopy biopsy. Surgery combined with amphotericin B liposome（60 rng/d for three weeks）was applied to one patient who was cured with no recurrence after a 22 month follow-up. Three cases were given amphotericin B liposome （ a newborn with 7mg/d for 62 days, the other two 60 mg/d for 31 days and 70 mg/d for 71 days respectively）. All had achieved marked response with follow up from 8 to 29 months, but one patient relapsed and died of recurrent lung mucormycosis. The other three patients were treated with itraconazole 400 -200 mg/d from 21 clays to 1 year with duration of follow up from 1 month to 20 months. One patient was not evaluable due to missing. Two patients relapsed and one died. Conclusion Pulmonary mucormycosis is difficult to diagnose and treat with a high mortality. Percutaneous tranthoracic lung biopsy is a useful diagnostic method. Amphotericin B liposome or itraconazole may be active against mucus. Early control of causes is essential to improve the prognosis and reduce the recurrence in patients with pulmonary mucormycosis.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2014年第3期206-209,共4页
Chinese Journal of Internal Medicine
