肺放线菌病临床回顾性分析
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摘要
目的探讨肺放线菌病的临床特征、影像学表现、诊治方法及预后,提高临床诊治水平。方法收集中国知网数据库1975年3月—2017年12月报道的经病理确诊的83例肺放线菌病的临床及影像学资料。结果本组均表现为咳嗽、咳脓性痰,入院初期均误诊,误诊率100%,误诊时间3 d～8年,误诊为肺炎39例次,肺癌32例次,肺结核20例次,胸腔积液9例次,肺脓肿4例次,支气管扩张、阻塞性肺炎各3例次,炎性假瘤、结核性胸膜炎各2例次,肺结节、肺不张、肺部占位、双肺转移癌、肺化脓性炎、肺肿块、先天性心脏病、肺真菌病各1例次。后进一步完善医技检查,确诊为肺放线菌病,75例予抗生素治疗,8例行单纯手术治疗,其中78例治疗后好转,5例死亡。结论肺放线菌病缺乏典型的临床症状,选择合适的检查方法是减少误诊的关键。
Objective To investigate the clinical chracteristics, imaging findings, diagnosis and treatment methods, and prognosis of pulmonary actinomycosis, and to improve the level of clinical diagnosis and treatment.Methods The clinical and imaging data of 83 patients with pulmonary actinomycosis confirmed by pathology were searched from CNKI collected between March 1975 and December 2017 and retrospectively analyzed. Results The main clinical symptoms of all patients included cough with yellow purulent sputum. They were misdiagnosed at admission, with a misdiagnosis rate of 100%, and the duration of diagnosis was 3 d-8 years. Major misdiagnosed diseases were 39 cases of pneumonia, 32 cases of lung cancer, 20 cases of pulmonary tuberculosis. 9 cases of pleural effusion, 4 cases of lung abscess, 3 cases of bronchiectasis, and 3 cases of obstructive pneumonia. In addition, there were inflammatory pseudotumor and tuberculous pleurisy in 2 cases, as well as pulmonary nodules, atelectasis, pulmonary placeholder, metastatic carcinoma of both lungs, pulmonary suppurative inflammation, lung mass, congenital heart disease, and pulmonary mycosis in 1 case, respectively. After further perfecting medical examination, diagnosis of pulmonary actinomycosis was confirmed. Seventy-five patients were treated with antibiotics, and 8 patients underwent surgery alone. Of these, the condition of 78 patients was improved after treatment and 5 patients died. Conclusion Pulmonary actinomycosis has atypical clinical symptoms, therefore, appropriate examination methods are the key to reducing misdiagnosis.
Objective To investigate the clinical chracteristics, imaging findings, diagnosis and treatment methods, and prognosis of pulmonary actinomycosis, and to improve the level of clinical diagnosis and treatment.Methods The clinical and imaging data of 83 patients with pulmonary actinomycosis confirmed by pathology were searched from CNKI collected between March 1975 and December 2017 and retrospectively analyzed. Results The main clinical symptoms of all patients included cough with yellow purulent sputum. They were misdiagnosed at admission, with a misdiagnosis rate of 100%, and the duration of diagnosis was 3 d-8 years. Major misdiagnosed diseases were 39 cases of pneumonia, 32 cases of lung cancer, 20 cases of pulmonary tuberculosis. 9 cases of pleural effusion, 4 cases of lung abscess, 3 cases of bronchiectasis, and 3 cases of obstructive pneumonia. In addition, there were inflammatory pseudotumor and tuberculous pleurisy in 2 cases, as well as pulmonary nodules, atelectasis, pulmonary placeholder, metastatic carcinoma of both lungs, pulmonary suppurative inflammation, lung mass, congenital heart disease, and pulmonary mycosis in 1 case, respectively. After further perfecting medical examination, diagnosis of pulmonary actinomycosis was confirmed. Seventy-five patients were treated with antibiotics, and 8 patients underwent surgery alone. Of these, the condition of 78 patients was improved after treatment and 5 patients died. Conclusion Pulmonary actinomycosis has atypical clinical symptoms, therefore, appropriate examination methods are the key to reducing misdiagnosis.
引文
[1]蒋延文,孙越,方秋红.肺放线菌病临床特点及诊断研究[J].中华医院感染学杂志,2014,24(14):3479-3481.
[2]戚兆亮,魏彩云.肺放线菌病1例[J].实用医药杂志,2015,32(10):924.
[3]吴晓华,马大庆,张淑红,等.酷似肺癌的肺放线菌病2例影像分析[J].中国医学影像学杂志,2013,21(7):543-544.
[4]王立源,张延伟,王慧,等.肺真菌病临床影像学分析[J].放射学实践,2014,29(6):651-653.
[5]柴晓明,杨秀荣.肺放线菌病的CT诊断及误诊分析[J].中华放射学杂志,2013,47(6):509-512.
[6]Sun X F,Wang P,Liu H R,et al.A Retrospective Study of Pulmonary Actinomycosis in a Single Institution in China[J].Chin Med J(Engl),2015,128(12):1607-1610.
[7]Kim S R,Jung L Y,Oh I J,et al.Pulmonary actinomycosis during the first decade of 21st century:cases of 94 patients[J].BMC Infect Dis,2013,13:216.
[8]李娟,王开金.肺放线菌感染伴炎性假瘤1例[J].中国感染与化疗杂志,2018,18(4):426-427.
[9]孙静,方苏榕.支气管腔内肺放线菌病误诊病例讨论[J].临床误诊误治,2018,31(6):1-3.
[10]陈婷婷,王莹,王瑾瑜,等.肺放线菌病2例及相关文献复习[J].沈阳医学院学报,2017,19(5):407-411.
[11]纪明宇.放线菌临床感染研究进展[J].中华实用诊断与治疗杂志,2017,31(8):815-817.
[12]刘佳.1例肺放线菌病的诊断及治疗[J].中国现代药物应用,2017,11(14):135-136.
[13]井梦昕,周贤梅.左上肺放线菌病一例误诊分析[J].临床误诊误治,2017,30(4):15-17.
[14]张建勇,和燕斐,杨瑞.肺放线菌病7例CT影像学观察及文献复习[J].临床放射学杂志,2016,35(11):1680-1683.
[15]张雪,仇煜,荣光生.支气管异物并发肺部放线菌病[J].临床肺科杂志,2016,21(3):568-571.
[16]方翔,汤兵祥.肺放线菌病15例临床分析[J].医药论坛杂志,2016,37(1):19-21.
[17]岳莉,闫国梁.胸部放线菌病的X线平片和CT影像特点研究[J].中国CT和MRI杂志,2015,13(12):4-6.
[18]张卫红,刘志彬,田素红,等.肺脓肿切除术后并发放线菌肺部感染1例[J].中国感染与化疗杂志,2015,15(6):594-595.
[19]高亭,李敏,马玉娟,等.支气管放线菌病1例并文献复习[J].中国热带医学,2015,15(10):1266-1269.
[20]赵海军,姜平.肺放线菌病误诊为肺结核3例[J].中国医药指南,2015,13(6):215.
[21]孙元亮,罗东兰,陈正贤.肺放线菌病误诊为周围型肺癌临床分析[J].中国综合临床,2009,25(7):712-714.
[2]戚兆亮,魏彩云.肺放线菌病1例[J].实用医药杂志,2015,32(10):924.
[3]吴晓华,马大庆,张淑红,等.酷似肺癌的肺放线菌病2例影像分析[J].中国医学影像学杂志,2013,21(7):543-544.
[4]王立源,张延伟,王慧,等.肺真菌病临床影像学分析[J].放射学实践,2014,29(6):651-653.
[5]柴晓明,杨秀荣.肺放线菌病的CT诊断及误诊分析[J].中华放射学杂志,2013,47(6):509-512.
[6]Sun X F,Wang P,Liu H R,et al.A Retrospective Study of Pulmonary Actinomycosis in a Single Institution in China[J].Chin Med J(Engl),2015,128(12):1607-1610.
[7]Kim S R,Jung L Y,Oh I J,et al.Pulmonary actinomycosis during the first decade of 21st century:cases of 94 patients[J].BMC Infect Dis,2013,13:216.
[8]李娟,王开金.肺放线菌感染伴炎性假瘤1例[J].中国感染与化疗杂志,2018,18(4):426-427.
[9]孙静,方苏榕.支气管腔内肺放线菌病误诊病例讨论[J].临床误诊误治,2018,31(6):1-3.
[10]陈婷婷,王莹,王瑾瑜,等.肺放线菌病2例及相关文献复习[J].沈阳医学院学报,2017,19(5):407-411.
[11]纪明宇.放线菌临床感染研究进展[J].中华实用诊断与治疗杂志,2017,31(8):815-817.
[12]刘佳.1例肺放线菌病的诊断及治疗[J].中国现代药物应用,2017,11(14):135-136.
[13]井梦昕,周贤梅.左上肺放线菌病一例误诊分析[J].临床误诊误治,2017,30(4):15-17.
[14]张建勇,和燕斐,杨瑞.肺放线菌病7例CT影像学观察及文献复习[J].临床放射学杂志,2016,35(11):1680-1683.
[15]张雪,仇煜,荣光生.支气管异物并发肺部放线菌病[J].临床肺科杂志,2016,21(3):568-571.
[16]方翔,汤兵祥.肺放线菌病15例临床分析[J].医药论坛杂志,2016,37(1):19-21.
[17]岳莉,闫国梁.胸部放线菌病的X线平片和CT影像特点研究[J].中国CT和MRI杂志,2015,13(12):4-6.
[18]张卫红,刘志彬,田素红,等.肺脓肿切除术后并发放线菌肺部感染1例[J].中国感染与化疗杂志,2015,15(6):594-595.
[19]高亭,李敏,马玉娟,等.支气管放线菌病1例并文献复习[J].中国热带医学,2015,15(10):1266-1269.
[20]赵海军,姜平.肺放线菌病误诊为肺结核3例[J].中国医药指南,2015,13(6):215.
[21]孙元亮,罗东兰,陈正贤.肺放线菌病误诊为周围型肺癌临床分析[J].中国综合临床,2009,25(7):712-714.