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目的探讨肺毛霉病(PM)的临床特点和治疗措施,提高医务人员对该病的认识,降低病死率。方法回顾性分析济宁医学院附属医院呼吸科收治的2例PM患者的病历资料,同时进行相关文献复习。以“肺毛霉菌病”为检索词检索中国知网(CNKI)数据库,以“pulmonary mucormycosis”为检索词检索Pubmed数据库,检索时间为2000年1月到2016年6月。结果患者1,男性,2014年2月7日以“咳嗽、咳痰伴憋喘5 d”收入院。胸部计算机断层成像(CT)提示:右肺上叶结节,邻近右肺上叶尖段支气管截断。2014年2月16日行电子支气管镜检查,活检病理组织中见毛霉菌,确诊后给予两性霉素B治疗好转出院。患者2,女性,2015年1月16日以“咳嗽、咳痰伴发热10+d”收入院。胸部CT示双肺纹理增强、紊乱,双肺内见多发大小不等的圆形结节、空洞,边界清楚,其中最大空洞直径约1.8 cm,部分空洞内见软组织密度影。行CT引导下肺穿刺,穿刺病理组织回示大部分为坏死性肉芽组织,其中见真菌菌丝,符合毛霉菌感染。确诊后给予两性霉素B、伏立康唑、泊沙康唑治疗,效果欠佳,患者自动出院,1周后死亡。文献检索经过严格筛选,最终收集病历资料完整的6篇文献进行PM临床特点及治疗措施的归纳总结。PM患者临床表现无特异性,多合并基础疾病,从出现症状到确诊约需要37.5 d。CT以及组织病理学检查有助于早期诊断,及时抗真菌治疗有助于改善预后。结论 PM是一种罕见的侵袭性真菌病,病死率高,临床表现无特异性,早期诊断、及时治疗是降低病死率的关键。
Objective To investigate the clinical characteristics and treatment of pulmonary mucormycosis (PM) and to improve the understanding of medical staff and reduce the mortality. Methods Retrospective analysis of medical records data of 2 cases of PM patients admitted to Department of Respiratory Medicine, Jining Medical College Affiliated Hospital, and review of related literatures at the same time. The database of CNKI was searched with the word “pulmonary mucormycosis” and the Pubmed database was searched with the word “pulmonary mucormycosis”. The search time ranged from January 2000 to June 2016. Results Patients 1, male, February 7, 2014 with “cough, sputum with wheezing 5 d ” income hospital. Chest Computed Tomography (CT) Tip: The right upper lobe nodule, adjacent to the right upper lobe of the bronchus, is severed. February 16, 2014 line of electronic bronchoscopy, biopsy see Mucor pathology, confirmed the treatment of amphotericin B improved after discharge. Patient 2, female, January 16, 2015 With “Cough, expectoration with fever 10 + d” income hospital. Chest CT showed double lung texture enhancement, disorder, multiple pulmonary lesions seen in varying sizes round, hollow, clear boundary, the largest hole diameter of about 1.8 cm, see the soft tissue density in some hollow shadow. CT-guided lung puncture, puncture pathology showed most of the necrotic granulation tissue, which see the fungal mycelium, in line with Mucormycosis. Confirmed after giving amphotericin B, voriconazole, posaconazole treatment, the effect is poor, patients were discharged automatically, died after 1 week. After rigorous screening of the literature search, the final collection of 6 complete records of medical records of PM clinical features and treatment summary. PM patients with non-specific clinical manifestations, multiple underlying diseases, from the onset of symptoms to diagnose about 37.5 d. CT and histopathology help early diagnosis, timely anti-fungal treatment can help improve the prognosis. Conclusion PM is a rare invasive fungal disease with high mortality and no specific clinical manifestations. Early diagnosis and prompt treatment are the keys to reduce mortality.