社区获得性肺真菌病的诊治探讨

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1、社区获得性肺真菌病的诊治探讨王文敏（台州市立医院318000）【摘要】目的探讨社IX获得性肺真菌病的临床和病原学特点、诊断方法及预后。方法回顾性分析浙江大学医学院附属第二医院和台州市立医院自2010年1月至2011年2刃的23例社区获得性肺真菌病患者的临床资料，对临床表现、影像学、病原学、诊断和治疗进行评估。结果23例患者中10例无明显基础疾病,13例患者存在导致免疫下降的基础疾病诱因。临床症状无明显特异性，以咳嗽、咳痰及咯血多见。胸部CT表现以肺内空洞伴球形阴影者多见。23例中19例有明确的微牛.物学或病理学依据，4例为临床经验性诊断。16例患者经手术或抗真菌药物治疗后获得较好的疗效

2、（有效率84.2%）。但两性霉素B治疗后出现了明显不良反应。结论社IX获得性肺真菌病临床表现缺少特异性。增强对该疾病影像学特征的认识，对可疑病例应反复多次痰病原学检查，及早行有创的侵入性检查。根据患者的实际情况及病灶特点，合理采用手术和抗真菌药物是治疗的关键。【关键词】肺真菌病诊断【中图分类号】R563【文献标识码】A【文章编号】2095-1752（2013）18-0114-03Retrospectiveanalysisondiagnosisandtreatmentofcommunityacquiredpulmonarymycosis[Abstract]Objective:Toanal

3、yseclinicalandetiologicfeature,diagnosisandprognosisofcommunityacquiredpulmonarymycosis.Methods:Retrospectivelyanalysetheclinicaldataof23patientswhowerediagnosedcommunityacquiredpulmonarymycosisbetweenJanuary2010andFebruary2011intheSecondAffiliatedHospitalofMedicalCollege,ZhejiangUniversityandTa

4、izhouMunicipalHospital,andevaluatetheirclinicalmanifestations,imageologicandetiologicfeatures,diagnosisandtreatment.Results:10casesofthe23patientswerediagnosedwithoutunderlyingdiseases,whiletheother14caseswithunderlyingdiseasescontributingtoimmunodepression.Theclinicalmanifestationsofthesepatien

5、tswerenotspecific,whichusuallywerecough,expectorationandhemoptysis.ChestCTscanmostlyindicatedintrapulmonarycavitiesaccompaniedglobularinfiltrations.Definitemicrobiologicorpathologicevidencewerefoundin19cases,andtheother4caseswereclinicaldiagnosed.16casesweretreatedeffectivelywithoperationoranti-

6、fungustherapy(totalefficacy84.2%).AdversereactionsofamphotericinBwerecommoninanti-fungustherapy.Conclusion:Becausetheclinicalmanifestationsofthepatientswithcommunityacquiredpulmonarymycosiswerenotspecific,imageologiccharacteristicofthisdiseaseshouldbewellrecognized.Repeatedsputumcultureandearlyi

7、nvasiveexaminationshouldberecommendedinthosesuspectedcases.Itisimportanttochoosearationalregimenaccordingtostatesofthepatientsandcharacteristicoffocuses.【Keywords】pulmonarymycosisdiagnosis社区获得性肺真菌病是并不少见的呼吸系统真菌性疾病，人多出现于机体免疫功能