Liu Z B, Zhang F, Liang C Y, Chen W H, Wang Y M, Cui X J, Zhao L, Cao B
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Gerontology, Shijiazhuang People's Hospital, Shijiazhuang 050011, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2024 Oct 12;47(10):946-954. doi: 10.3760/cma.j.cn112147-20240426-00223.
To analyze the clinical characteristics of patients with pulmonary mucormycosis treated with and without surgery. This was a single-center, retrospective study. We retrieved "pulmonary mucormycosis" from the electronic medical records of China-Japan Friendship Hospital between 2016 and 2022. A total of 29 patients with pulmonary mucormycosis were collected. There were 19 males and 10 females with a median age of 49 (47, 67) years. Mann-Whitney test, χ² test, Kaplan-Meier curve and log-rank test were used to compare the differences between groups. The most common underlying disease was diabetes (19, 65.5%). The most frequent imaging findings were consolidation (25, 86.2%) and nodule or mass (21, 72.4%). Bronchial stenosis (16, 55.2%), obstruction by fungal plugs (18, 62.1%), pseudomembranous necrotizing bronchitis (19, 65.5%) were common. Treatment strategies were developed by the multi-disciplinary team (MDT). Among 16 patients who did not undergo surgery, 10 had bilateral multifocal lesions and 6 had unifocal lesions. All patients received antifungal therapies, and surgeries were performed in 13 (44.8%) patients. Patients who underwent surgery had numerically lower in-hospital mortality (15.4% 31.3%, =0.410). Involvement of unilateral multiple lesions was more common in patients who underwent surgeries (6/13 1/16, =0.019). Patients who underwent surgery were more likely to have lobar and segmental bronchial involvement (13/13 9/16, =0.007). A total of 15 patients underwent mNGS, 14 (93.3%) had positive results. Performing metagenomic next generation sequencing for diagnosis shortened the time from disease onset to diagnosis (log-rank =0.014). Metagenomic next-generation sequencing aided early diagnosis. The patients who underwent surgery included unilateral multiple lesions and visualisation of endobronchial abnormalities on lobar or segmental bronchus in unilateral lung.
分析接受手术和未接受手术治疗的肺毛霉病患者的临床特征。这是一项单中心回顾性研究。我们从2016年至2022年中日友好医院的电子病历中检索“肺毛霉病”。共收集到29例肺毛霉病患者。其中男性19例，女性10例，中位年龄为49（47，67）岁。采用曼-惠特尼检验、χ²检验、Kaplan-Meier曲线和对数秩检验比较组间差异。最常见的基础疾病是糖尿病（19例，65.5%）。最常见的影像学表现为实变（25例，86.2%）和结节或肿块（21例，72.4%）。支气管狭窄（16例，55.2%）、真菌栓阻塞（18例，62.1%）、假膜性坏死性支气管炎（19例，65.5%）较为常见。治疗策略由多学科团队（MDT）制定。在16例未接受手术的患者中，10例为双侧多灶性病变，6例为单灶性病变。所有患者均接受抗真菌治疗，13例（44.8%）患者接受了手术。接受手术的患者院内死亡率在数值上较低（15.4%对31.3%，P = 0.410）。单侧多灶性病变在接受手术的患者中更为常见（6/13对1/16，P = 0.019）。接受手术的患者更易出现叶和段支气管受累（13/13对9/16，P = 0.007）。共有15例患者接受了宏基因组下一代测序（mNGS），14例（93.3%）结果为阳性。进行宏基因组下一代测序诊断缩短了从发病到诊断的时间（对数秩P = 0.014）。宏基因组下一代测序有助于早期诊断。接受手术的患者包括单侧多灶性病变以及单侧肺叶或段支气管内支气管异常的可视化。
