Wang Ling, Wu Yifan, Xu Jinfu, Wei Ping, Lu Haiwen
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
J Thorac Dis. 2024 Sep 30;16(9):5650-5662. doi: 10.21037/jtd-24-624. Epub 2024 Sep 21.
Lung abscess in the apical segment of the lung is not rare and is often underestimated in clinical practice. However, the clinical features of apical segment lung abscess (AL) have scarcely been reported. Hence, this study aimed to determine the clinical characteristics of AL and explore moderate therapeutic strategies.
This was a retrospective, single-center cohort study. We reviewed the medical records of consecutive patients who were admitted to Shanghai Pulmonary Hospital in Shanghai, China, from January 2009 to December 2018. This study collected information on patients with lung abscess, including demographics, symptoms, clinical findings, and treatment. The statistical methods used were descriptive statistics, Chi-squared test, Fisher's exact test, -tests, and logistic regression analysis.
Of 824 patients, 431 with lung abscess were finally eligible after a review of medical records. The patients were divided into two groups: the AL group (n=68) and the non-apical segment lung abscess (NAL) group (n=363). Compared with patients in the NAL group, those in the AL group had lower rates of chronic obstructive pulmonary disease (COPD) (5.9% 17.4%, P=0.02), diabetes (14.7% 32.2%, P=0.004) and hypoprealbuminemia (10.3% 25.3%, P=0.007). Regarding clinical symptoms, patients in the AL group exhibited lower fever (38.2% 58.4%, P=0.002) and less purulent sputum (32.4% 45.5%, P=0.045). Moreover, regarding radiological features, the AL group had a lower proportion of air-fluid level on chest computed tomography (CT) (7.4% 16.8%, P=0.047). In addition, the study demonstrated that the AL group had a shorter duration of intravenous antibiotic treatment [8 (7-8) 10 (8-12) days, P <0.001]. Surprisingly, the AL group had a high rate of surgical treatment (36.8% 15.4%, P<0.001). In multivariate analysis, surgical treatment occurred more frequently in patients with AL [odds ratio (OR): 2.58, 95% confidence interval (CI): 1.40-4.77, P=0.002], lower in patients who had fever (OR: 0.55, 95% CI: 0.31-0.98, P=0.04), and imaging features of liquefaction necrosis (OR: 0.32, 95% CI: 0.15-0.69, P=0.004).
Patients with AL presented with atypical and relatively mild clinical symptoms. However, the rate of surgical treatment was significantly higher. These data should be considered when managing the AL.
肺尖段肺脓肿并不罕见，在临床实践中常被低估。然而，关于肺尖段肺脓肿（AL）的临床特征鲜有报道。因此，本研究旨在确定AL的临床特征并探索适度的治疗策略。
这是一项回顾性单中心队列研究。我们回顾了2009年1月至2018年12月在中国上海上海肺科医院连续收治患者的病历。本研究收集了肺脓肿患者的信息，包括人口统计学、症状、临床检查结果和治疗情况。所采用的统计方法包括描述性统计、卡方检验、Fisher精确检验、t检验和逻辑回归分析。
在824例患者中，经病历审查后，最终有431例肺脓肿患者符合条件。患者被分为两组：AL组（n = 68）和非肺尖段肺脓肿（NAL）组（n = 363）。与NAL组患者相比，AL组患者慢性阻塞性肺疾病（COPD）发生率较低（5.9% 对17.4%，P = 0.02）、糖尿病发生率较低（14.7% 对32.2%，P = 0.004）以及低蛋白血症发生率较低（10.3% 对25.3%，P = 0.007）。关于临床症状，AL组患者发热率较低（38.2% 对58.4%，P = 0.002）且脓性痰较少（32.4% 对45.5%，P = 0.045）。此外，关于影像学特征，AL组胸部计算机断层扫描（CT）上出现气液平面的比例较低（7.4% 对16.8%，P = 0.047）。另外，研究表明AL组静脉使用抗生素治疗的持续时间较短[8（7 - 8）天 对10（8 - 12）天，P <0.001]。令人惊讶的是，AL组手术治疗率较高（36.8% 对15.4%，P <0.001）。在多因素分析中，AL患者手术治疗更为频繁[比值比（OR）：2.58，95%置信区间（CI）：1.40 - 4.77，P = 0.002]，发热患者手术治疗较少（OR：0.55，95% CI：0.31 - 0.98，P = 0.04），以及具有液化坏死影像学特征的患者手术治疗较少（OR：0.32，95% CI：0.15 - 0.69，P = 0.004）。
AL患者表现出非典型且相对较轻的临床症状。然而，手术治疗率明显较高。在管理AL时应考虑这些数据。
