作　　者： (杨胡琴）; (施焕中）; (童朝晖）;

机构地区： 首都医科大学附属北京朝阳医院呼吸与危重症医学科，100020

出　　处： 《中华结核和呼吸杂志》 2017年第8期588-591,共4页

摘　　要： 目的 探讨奴卡菌病的临床特点、影像学表现及治疗情况,为临床医生早期诊断及治疗提供帮助.方法 收集北京朝阳医院2010年1月至2016年1月确诊为奴卡菌病患者的临床资料并进行分析.结果 13例中男6例,女7例,年龄21~85岁,平均（51±17）岁.其中肺奴卡菌病12例,播散性奴卡菌病1例.3例合并自身免疫性疾病并长期服用激素（2例自身免疫性溶血性贫血,1例系统性红斑狼疮）,6例合并支气管扩张.常见症状为咳嗽、咳痰及发热,常见的胸部CT表现为结节或团块影、支气管扩张、磨玻璃影、空洞及胸膜增厚.经痰涂片检验确诊6例,经支气管肺泡灌洗确诊4例,经皮肺穿刺活检确诊2例,肾周脓肿穿刺确诊1例.确诊后分别应用磺胺甲噁唑/甲氧苄啶、阿米卡星、头孢菌素类、碳青霉烯类、米诺环素及利奈唑胺等抗生素治疗,13例患者均好转出院.结论 奴卡菌病中最常见的为肺奴卡菌病,常见的临床表现为咳嗽、咳痰及发热,影像学表现为结节、团块影或支气管扩张.因奴卡菌病临床及影像学表现不典型,微生物分离及培养较困难,故确诊时间长,因此,临床疑诊对疾病的早期诊断和及时治疗非常必要. Objective To evaluate the clinical features, chest radiological manifestations, microbiological examination and treatments of nocardial disease.Methods A retrospective study was conducted to analyze the data of patients with nocardial infection admitted to Beijing Chaoyang Hospital from January 2010 to January 2016.Results The 13 patients, 6 males and 7 females, aged （51±17） years.Twelve cases were diagnosed with pulmonary nocardiosis, and 1 with disseminated nocardial infection.Most of these patients had complications： autoimmune diseases in 3 （2 with autoimmune hemolytic anemia and 1 with systemic lupus erythematosus）, and bronchiectasis in 6 patients.The most common symptoms were cough, expectoration and fever.The main manifestations of CT scans included nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening.Six cases were confirmed by sputum smear microscopy, 4 by bronchoalveolar lavage, 2 by percutaneous lung biopsy and 1 by renal abscess puncture.After diagnosis, antibiotics such as Co-trimoxazole, amikacin, cephalosporins, imipenem, minomycin, or linezolid were used, and the 13 patients were all cured and discharged.ConclusionsPulmonary nocardiosis was the most common clinical presentation of nocardial infection.Cough, expectoration and fever were the most common symptoms.The main findings of CT scans were nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening.The diagnosis of nocardiosis was not easy because of the non-specific clinical presentations and difficult culture of nocardia spp.Thus, high clinical suspicion of nocardiosis is necessary for earlier diagnosis and treatment.

关 键 词： 放线菌病 诊断