[43例经病理确诊的肺真菌病患者临床特征分析]
[Analysis of clinical characteristics of 43 patients with pulmonary mycosis diagnosed by pathology].
作者信息
Li Zhao, Wang Quanyi, Cao Xinna, Jiang Luning
机构信息
Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, China.
Department of Pathology, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, China.
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Feb;33(2):237-240. doi: 10.3760/cma.j.cn121430-20200722-00537.
OBJECTIVE
To observe the etiological distribution, clinical presentations and imaging features of pulmonary mycosis that is diagnosed by pathology.
METHODS
The etiological distribution, clinical presentations and imaging features of patients with pulmonary mycosis, who were collected in the Affiliated Hospital of Jining Medical University from January 2018 to July 2020, were retrospectively analyzed. The diagnosis of all the patients were confirmed by pathological examination, of lung or bronchi tissue that were obtained through operation, bronchoscope or percutaneous lung puncture biopsy.
RESULTS
There were 26 patients' (60.47%, 26/43) pathological specimens were obtained by operation, 14 cases (32.56%, 14/43) were obtained by bronchoscope, and 3 cases (6.98%, 3/43) were obtained by percutaneous lung puncture biopsy. Of the 43 patients who were diagnosed pulmonary mycosis by pathology, 27 patients (62.79%, 27/43) suffered from pulmonary aspergillosis, 11 patients (25.58%, 11/43) suffered from pulmonary cryptococcosis, 3 patients (6.98%, 3/43) suffered from pulmonary mucormycosis, and 2 patients (4.65%, 2/43) suffered from pulmonary candidiasis. There were 27 patients (62.79%, 27/43) with pulmonary fungal disease complicating risk factors of fungal infection, including diabetes mellitus (23.26%,10/43), malignant tumor (16.28%, 7/43), bronchiectasis (9.30%, 4/43), hepatitis B virus (HBV) carrier (6.98%, 3/43), taking glucocorticoids (4.65%, 2/43), pulmonary tuberculosis (4.65%, 2/43), and chemotherapy following colon carcinoma operation (2.33%, 1/43). The common clinical presentations included cough (55.81%, 24/43), expectoration (48.84%, 21/43), hemoptysis (37.21%, 16/43), fever (20.93%, 9/43), gasping (18.60%, 8/43), chest pain (16.28%, 7/43), and hoarseness (3.13%, 1/43). Imaging features of chest included lung nodes in 20 cases (46.51%, 20/43), vascular welt sign in 12 cases (27.91%, 12/43), exudative process in 10 cases (23.26%, 10/43), lung mass or consolidation in 8 cases (18.60%, 8/43), cavitary lesions in 7 cases (16.28%, 7/43), thicken bronchus wall and narrow lumina in 6 cases (13.95%, 6/43), air crescent in 5 cases (11.63%, 5/43).
CONCLUSIONS
The pulmonary aspergillosis and cryptococcosis are mainly in pulmonary mycosis diagnosed by pathology. The common complications are diabetes mellitus and malignant tumor. The common clinical presentations are cough, expectoration, and hemoptysis. The main imaging features of chest are lung nodes and vascular welt sign can be found in most of pulmonary cryptococcosis.
目的
观察经病理确诊的肺真菌病的病因分布、临床表现及影像学特征。
方法
回顾性分析2018年1月至2020年7月济宁医学院附属医院收治的肺真菌病患者的病因分布、临床表现及影像学特征。所有患者均经手术、支气管镜或经皮肺穿刺活检获取肺或支气管组织病理检查确诊。
结果
43例患者中，手术获取病理标本26例（60.47%，26/43），支气管镜获取14例（32.56%，14/43），经皮肺穿刺活检获取3例（6.98%，3/43）。43例经病理确诊的肺真菌病患者中，肺曲霉菌病27例（62.79%，27/43），肺隐球菌病11例（25.58%，11/43），肺毛霉菌病3例（6.98%，3/43），肺念珠菌病2例（4.65%，2/43）。27例（62.79%，27/43）肺部真菌病患者合并真菌感染危险因素，包括糖尿病（23.26%，10/43）、恶性肿瘤（16.28%，7/43）、支气管扩张（9.30%，4/43）、乙型肝炎病毒（HBV）携带者（6.98%，3/43）、服用糖皮质激素（4.65%，2/43）、肺结核（4.65%，2/43）、结肠癌术后化疗（2.33%，1/43）。常见临床表现包括咳嗽（55.81%，24/43）、咳痰（48.84%，21/43）、咯血（37.21%，16/43）、发热（20.93%，9/43）、气喘（18.60%，8/43）、胸痛（16.28%，7/43）、声音嘶哑（3.13%，1/43）。胸部影像学特征：肺结节20例（46.51%，20/43），血管纹理增粗12例（27.91%，12/43），渗出性病变10例（23.26%，10/43），肺肿块或实变8例（18.60%，8/43），空洞性病变7例（16.28%，7/43），支气管壁增厚管腔狭窄6例（13.95%，6/43），空气新月征5例（11.63%，5/43）。
结论
经病理确诊的肺真菌病以肺曲霉菌病和肺隐球菌病为主。常见并发症为糖尿病和恶性肿瘤。常见临床表现为咳嗽、咳痰、咯血。胸部主要影像学特征为肺结节，多数肺隐球菌病可见血管纹理增粗。
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