肺曲菌病41例临床病理剖析.docVIP

肺曲菌病41例临床病理剖析 　　[摘要] 目的：探讨肺曲菌病的临床和病理学特点。方法：对41例经病理及临床证实为肺曲菌病的临床及病理资料进行回顾性分析。结果：肺曲菌病的临床表现无特异性。本组原发曲菌病10例，继发曲菌病21例，其中，肺脓肿8例，肺结核、支气管囊肿各4例，支气管扩张症3例，肺癌2例（含1例同时合并肺癌和肺结核），支气管肺炎1例。X线及CT主要征象包括斑片状、片状或点片状渗出影。结论：肺曲菌病的临床和影像学表现多种多样，认识不足容易导致误诊，支气管镜活检有利于临床诊断并进行治疗。 　　[关键词] 肺疾病；曲菌病；病理 　　[中图分类号]R445 [文献标识码]B [文章编号]1673-7210（2008）06（a）-060-02 　　 　　Clinicopathological analysis of 41 pulmonary aspergillosis 　　LU Fu-dong1,ZHANG Li-li2，ZHANG Chang-huai1 　　(1.The Center for Clinical Laboratory Development of the Chinese Academy of Medical Sciences，Beijing 102206，China;2.Beijing Chest Hospital,Beijing 101149,China) 　　[Abstract] Objective:To study clinical diagnosis and pathologic features of pulmonary aspergillosis．Methods：41 cases verified by pathology and clinical diagnosis, collected for clinical and pathological features were retrospectively analyzed．Results：The clinical features of pulmonary aspergillosis had no special manifestations. Primary pulmonary aspergillosis was 10 cases. Secondary pulmonary aspergillosis was 21 cases, among them lung abscess was 8 cases, lung tuberculosis and bronchial cyst was 4 cases respectively, bronchiectasis was 3 cases, lung cancer was 2 cases, bronchopneumonia was 1 case. X-ray and CT main imaging which include spot sheet or sheet infiltrating sign(31/41).Conclusion:Clinical and imaging manifestations of pulmonary aspergillosis is varied which lead to misdiagnosis if lack of understanding. It is valualde of lung bronchoscopic biopsy for pulmonary aspergillosis and therapy． 　　[Key words] Pulmonary disease;Aspergillosis; Pathology 　　 　　肺曲菌病（pulmonary aspergilloma）是肺内少见的霉菌感染性疾病，当前随着抗生素、激素及免疫抑制剂的广泛应用和诊断技术的不断提高，其发病率和检出率呈增高趋势，但临床对本病的认识尚不足，容易忽视和误诊[1，2]。收集1981～1998年确诊为肺曲菌病的病例41例，对其临床特征及病理诊断进行分析。 　　1资料与方法 　　1.1一般资料 　　收集经病理证实的肺曲菌病41例。男29例，女12例，年龄20～74岁，平均50岁。主要临床表现：咳嗽34例（82.9%）；咳白黏痰21例(51.2％)；咳脓痰10例(24.4％)；咯血痰7例(17.1％)；发热18例(43.9％)；胸闷气短10例(24.4％)；胸痛4例(9.8％)；其他表现有纳差、消瘦、乏力、盗汗和喘息；无症状经体检发现13例；病程10 d～2个月。 　　1.2确诊方法 　　41例均病理确诊。其中外科手术后病理报告31例，纤维支气管镜下活检