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-  2018 

肺放线菌病三例并文献复习

DOI: doi:10.7507/1671-6205.201801050

Keywords: 肺放线菌病, 临床特点, 诊断, 治疗

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Abstract:

目的探讨肺放线菌病的临床特征、诊断及治疗。 方法对本院 3 例肺放线菌病及国内 65 例肺放线菌病的临床特征、诊断及治疗行回顾性分析。 结果68 例患者中,男 49 例,女 19 例,年龄 6~77 岁,中位年龄 47 岁,最常见的临床表现为咳嗽、咳痰、发热,实验室检查炎性指标轻度升高,最常见的发病部位在右上肺,最典型的 CT 表现为团块中心低密度液化坏死区,伴大小不等的空洞或多个类圆形小空泡形成,即“空洞-悬浮气泡征”。正电子发射计算机断层显像显示病灶呈轻度代谢增高。68 例患者多由手术、CT 引导下经皮肺穿刺、支气管镜活检确诊。从出现症状到最终确诊平均时长 10 个月,最长甚至达 6 年 5 个月,且首诊正确率为 5.9%。41 例单纯使用抗生素治疗,15 例抗生素联合手术治疗,12 例单纯手术治疗,治愈率达 88.7%。本院诊治的 3 例患者在积极药物治疗下,症状迁延不愈。 结论肺放线菌病临床特征不典型,误诊率高。当临床怀疑肺放线菌病时,应充分与微生物科沟通,确保厌氧环境下培养并延长培养周期,并积极行组织培养和病理活检明确诊断。治疗主要依靠抗生素或手术。既往报道治愈率高,但本院诊治的 3 例患者症状迁延不愈,提示部分肺放线菌病预后不乐观

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