摘要
目的提高对支气管扩张症(简称支扩)合并诺卡菌感染的认识。方法收集2016年3月至2020年3月国内9家三级综合医院支扩合并肺诺卡菌病患者的临床、影像和病原学等资料,对其进行回顾性分析,并结合文献复习。结果共收集支扩合并肺诺卡菌病患者资料17例,其中女性12例,男性5例,患者年龄45~79岁,平均(63±9)岁。不吸烟者15例,吸烟者2例。所有患者均为慢性病程,临床主要表现为咳嗽、咳痰、咯血、发热、呼吸困难等症状,影像表现为双肺支气管扩张,以左下肺、左舌叶和右中叶最常累及。痰培养阳性10例,BALF培养阳性6例,宏基因组二代基因测序(mNGS)阳性4例,其中盖尔森基兴诺卡菌2例、脓肿诺卡菌2例、星形诺卡菌2例、墨西哥诺卡菌1例、豚鼠耳炎诺卡菌1例、未确定类型诺卡菌属9例。合并肺炎克雷伯菌3例,铜绿假单胞菌2例,曲霉2例,非结核分枝杆菌1例,流感嗜血杆菌1例。所有患者经抗诺卡菌等治疗后症状好转,影像学改善。结论支扩合并肺诺卡菌病多见于不吸烟的中老年女性,临床常表现为慢性病程,支扩常累及左肺下叶、右肺中叶及左肺舌叶等肺叶。诺卡菌感染可能是支扩发生和发展的病因之一。
Objective To better understand the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis.Methods Patients diagnosed as bronchiectasis complicated with pulmonary nocardiosis in 9 tertiary general hospitals in China were enrolled from March 2016 to March 2020,with the record of general data,imaging performance and pathogen.The literature was reviewed.Results Totally 17 patients were included.There were 12 females and 5 males.The ages ranged from 45 to 79 years,with an average of(63±9)years.There were 15 nonsmokers and 2 smokers,all of whom with chronic course.The clinical manifestations were mostly cough,expectoration,hemoptysis,fever,and dyspnea.The imaging manifestation was bronchiectasis in both lungs,with the most common involvement in the left lower lung,right middle lobe and left lingual lobe.Sputum cultures were positive in 10 cases,bronchoalveolar lavage fluid(BALF)cultures were positive in 6 cases,and next generation gene sequencings were positive in 4 cases,including 2 cases of Nocardia gelsenkii,2 cases of Nocardia abscess,2 cases of Nocardia stellate,1 case of Nocardia mexicana,1 case of Nocardia otitis caviae,and 9 cases of undetermined Nocardia.There were 3 cases of Klebsiella pneumoniae,2 cases of Pseudomonas aeruginosa and 2 cases of Aspergillus.The symptoms and imaging of all patients were improved after anti Nocardia therapy.Conclusions Bronchiectasis combined with nocardiosis is more common in middle-aged and elderly women without smoking,which is similar to the clinical manifestations of Lady Windermere syndrome.Bronchiectasis often involves the left lower lobe,right middle lobe and left lingual lobe.Nocardia infection might further precipitate the initiation and progression of bronchiectasis.
作者
牟向东
郭文佳
蔡存良
赵景全
曾璞
王利君
肖楠
林连君
于丽
魏丽娟
张童
王瑞娟
吴剑琴
刁小莉
田欣伦
Mu Xiangdong;Guo Wenjia;Cai Cunliang;Zhao Jingquan;Zeng Pu;Wang Lijun;Xiao Nan;Lin Lianjun;Yu Li;Wei Lijuan;Zhang Tong;Wang Ruijuan;Wu Jianqin;Diao Xiaoli;Tian Xinlun(Department of Respiratory and Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Medical Center,Tsinghua University,Beijing 102218,China;Department of Clinical Laboratory,Beijing Tsinghua Changgung Hospital,Medical Center,Tsinghua University,Beijing 102218,China;Department of Geriatrics,the First Hospital of Peking University,Beijing 100034,China;Department of Internal Medicine,People′s Hospital of Gucheng County,Gucheng 253800,China;Department of Respiratory Medicine,Beijing Sixth Hospital,Beijing 100007,China;Department of Respiratory and Critical Care Medicine,Special Medical Center of Strategic Support Force,Beijing 100101,China;Department of Respiratory Medicine,Ji′an Hospital,Shanghai Oriental Hospital,Shanghai 343000,China;Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Peking Union Medical College Hospital,Beijing 100005,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2022年第3期276-281,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家重点研发计划(2020YFC2005401)
北京市属医院科研培育计划项目(PX2020041)
清华大学春风基金国内科研专项(2020Z99CFY033)。
