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肺放线菌病临床特点及诊断研究

ISSN号：1005-4529
期刊名称：《中华医院感染学杂志》
时间：0
分类：R563[医药卫生—呼吸系统;医药卫生—临床医学;医药卫生—内科学]
作者机构：[1]首都医科大学附属北京世纪坛医院呼吸与危重症学科,北京100038
相关基金：北京市卫生系统高层次卫生技术人才基金资助项目（2013-2-014）

关键词：肺放线菌病, 临床表现, 影像学特点, 诊断, Pulmonary actinomycosis, Clinical manifestation, Imaging feature, Diagnosis

中文摘要：

目的探讨肺放线菌病临床特点、影像学表现及诊断,从而提高临床医师对该病的诊治水平。方法检索1995-2013年18年中国知网收录的肺放线菌病历,选取资料较完整的48例,以及确诊的肺放线菌病2例,共50例,分析其临床资料。结果肺放线菌病发病以男性多见,好发年龄40-50岁;〉50.0%病程〉2个月;大多数患者有吸烟史,共35例占70.0%;常见的临床表现咳嗽、咳痰、咯血、发热、胸痛及呼吸困难,分别占96.0%、92.0%、64.0%、40.0%、34.0%及22.0%;最易误诊为肺癌,共28例占56.0%,其次为肺炎11例占22.0%;胸部影像学特点：病变多位于左肺下叶16例占32.0%,16例累及多个肺叶,19例累及多个肺段、1例累及胸壁软组织及肋骨;23例影像学示胸膜增厚;患者分别通过经皮肺穿刺活检14例,占28.0%、电子气管镜活检11例,占22.0%及术后病理活检22例,占44.0%,找到放线菌明确诊断。结论肺放线菌病的临床表现无特异,容易误诊,好发于吸烟、有肺部基础疾病者,最易误诊为肺癌和肺炎,对于临床疑诊为肺癌,虽经多次支气管镜检查仍无法明确诊断,应警惕肺放线菌病的可能。

英文摘要：

OBJECTIVE To explore the clinical characteristics of pulmonary actinomycosis,imaging features,and diagnosis so as to improve the level of clinical diagnosis and treatment of the disease.METHODS The medical records of pulmonary actinomycosis that were indexed in CNKI from 1995to 2013were retrieved,and 48cases with completed data and 2cases of confirmed pulmonary actinomycosis were enrolled,50cases in total;the clinical data were analyzed.RESULTS Most of the patients with pulmonary actinomycosis were male,with the age varying between 40and 50years old;more than 50.0%of the patients were with the disease course more than 2months;35cases had the history of smoking.Among the common clinical manifestations,the patients with cough accounted for 96.0%,the patients with sputum 92.0%,the patients with hemoptysis 64.0%,the patients with fever40.0%,the patients with chest pain 34.0%,the patients with dyspnea 22.0%.Totally 28cases were misdiagnosed as lung cancer,accounting for 56.0%,and 11cases were misdiagnosed as pneumonia,accounting for22.0%.The chest imaging features showed that 16（32.0%）cases were with the lesions locating in the left lower lobe,16cases with multiple lobes involved,19cases with multiple lung segments involved,1case with soft tissue of the chest wall and ribs involved,23cases with pleural thickening.Totally 14（28.0%）cases were confirmed with the pulmonary actinomycosis through percutaneous lung biopsy,11（22.0%）cases through electronic bronchoscopic biopsy,22（44.0%）cases through postoperative biopsy.CONCLUSION The clinical manifestations of pulmonary actinomycosis do not have specific features,it tends to be misdiagnosed and is prone to occur in those with smoking history or pulmonary underlying diseases.For the suspected clinical diagnosis of lung caner,although it can not be confirmed through many times of bronchoscopic examination,the possibility of pulmonary actinomycosis can not be excluded.

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