14例肺曲菌病临床,X线与纤支镜检

１４例肺曲菌病临床、Ｘ线与纤支镜检湖南省湘乡市人民医院内科（４１１４００）胡清平湖南医科大学湘雅医院呼吸科瞿素洁肺曲菌病过去认为是一种少见病，近年来本病的发病率有所增加，本文报告近５年来经纤维支气管镜刷检、活检确诊为肺曲菌病１４例，分析临床、Ｘ线与纤...     

纤支镜诊断成人肺门淋巴结核

我院自1988年以来行纤支镜检查成人肺门淋巴结核26例,总结报告如下.     

肺部非典型曲菌球病20例误诊分析

肺部曲首球病多维发于肺空洞性疾患[1]，因其临床及X线表现不典型，痰曲尽自检出率较低，而易误诊。为探讨其误诊因素，现将我院经手术后病理所见与X线对照观察的20例，并结合文献作一分析。1临床资科1．1性别年龄男12例，女8例，年龄16～67岁，平均42岁。1．2主要临床表现及误     

经纤维支气管镜诊断肺曲菌病（附4例报告）

近４年来，我们应用纤支镜诊断肺曲菌病４例，现报告如下。１临床资料例１女，４２岁。咳嗽，咯痰半个月，胸片示右上肺肺不张而行纤支镜检查。镜下见右上叶管口有一息肉状新生物，几乎完全阻塞管口，表面附有胶冻状分泌物，活检时感组织韧，无出血。刷检找到曲菌菌丝，病...     

纤支镜对以支气管肉芽肿为表现的肺曲菌病的诊断价值

目的：探讨纤支镜对以支气管肉芽肿为表现的肺曲菌病的诊断价值。方法：对12例以支气管腔内肉芽肿为主要表现的肺曲菌感染的纤支镜检查结果作一分析。结果：12例患者，以咳嗽和咯血为主，X线表现以肺不张多见，有基础疾病5例。纤支镜所见大部分位于两上叶，呈息肉肿块状7例，气管狭窄阻塞4例，3例呈粘膜改变为主。8例有略样坏死动物及黄色分泌物。结论：以支气管肉芽肿为主要表现的肺曲菌病纤支镜下所见的肿块、质硬、干酪样分泌物及黄色分泌物具有诊断特异性。     

不典型肺曲菌球病9例临床X线分析

我院自 1990年至 1999年共经手术肺叶切除病理确诊的肺曲菌球病患者 16例 ,其中术前因有典型Ｘ线表现而确诊的有 7例 ,其余 9例被误诊。为进一步提高对不典型肺曲菌球病的认识 ,将该 9例患者的临床资料结合文献复习总结如下。1　临床资料1.1　一般资料　 9例患者中男 3例 ,女 6例。年龄 18～ 6 4岁。所有患者均有咯血 ,绝大多数为痰中带血 (1天～ 7年 ) ,中、大量咯血各 1例 ,不规则低热 1例 ,胸痛 2例 ,明显消瘦 7例。术前诊断为肺结核或肺癌 7例 ,结核性空洞 2例。1.2　Ｘ线表现　 (1)部位 :右上肺 2例 ,左上肺 5例 ,左右下肺叶背段各 1例…     

侵袭性肺曲菌病1例

1临床资料患者老年女性,77岁,因发热、乏力6 d,行走时双下肢无力3 d入院。入院前6 d出现低热、乏力、食欲减退,当地医院查血常规:白细胞8.7×109/L,中性粒细胞88.7%,红细胞4.42×1012/L,血红蛋白132 g/L,血小板217×109/L,X线胸片示双下肺肺炎,诊断细菌性肺炎,给予强力阿莫仙静     

纤支镜肺活检大出血死亡二例

大出血乃是纤支镜肺活检时危险而严重的并发症。国外屡有报导,国内报导甚少,本文报告2例如下。例1:男,25岁。入院前一年因患“肺结核”反复咯血,曾多次住某医院行抗痨治疗,咯血仍不止。入院前一月(1981年9月)门诊胸透为“左上肺结核,病灶已硬结,边缘清晰,未见活动病灶”。胸片诊断为陈旧性肺结核。三次痰检抗酸杆菌阴性。入院前3小时在局麻下行纤支镜检查,见右中叶开口内外侧基底支上方外侧壁有一椭圆形突起包块,表面光滑,色泽与周围正常粘膜一致,中央部稍苍白,无波动感,于右中     

肺曲菌病15例临床病理分析

目的探讨肺曲菌病的临床和病理学特征。方法对15例经病理确诊的肺曲菌病进行回顾性研究。结果肺曲菌病病理学改变以坏死性肉芽肿性炎症为主,并可见特征性的菌丝和果实小体,亦可伴有草酸钙结晶、Splendore-Hoeppli现象和色素沉积。而临床及影像学表现多样。结论肺曲菌病临床表现无特异性,误诊率高,病理活检和病原体培养可以明确诊断。     

肺曲菌球病的外科治疗

1982年以来我院病理证实肺曲菌球病16例,为了提高对本病的认识,本文就外科治疗情况小结于下。 临床资料 一般资料:男16例、女2例。年龄20～30岁4例,31～40岁5例,41～57岁7例。在农村生活与工作者11例,矿工1例。既往8例有结核病史,3例有支气管扩张病史,有矽肺和糖尿病史者各1例。     

纤维支气管镜介入治疗肺曲菌病

1　病例资料例 1　男 ,62岁 ,因“刺激性干咳、间断咯血、消瘦 2月 ,气促、发热 5天于 1997年 10月 2 7日入院。有鸟禽饲养史。体检 :T37.5℃ ,右下肺呼吸音低 ,余无异常 ,胸部X线及CT检查示右中叶肺不张 ,右下叶支气管腔内肿块影。纤支镜检见右中、下叶开口处灰白色息肉样物堵塞 ,病理活检见凝固性坏死及大量曲霉菌。先后静滴大蒜素、氟康唑、二性霉素B共 75d ,症状渐重 ,不能平卧。纤支镜复检见曲菌团长至隆突 ,右主支气管腔堵塞 2 / 3。经纤支镜置6F导管于右下叶支气管腔内 ,每日分 4次腔内注射二性霉素B 5mg(生理盐水稀释 ) ,2周后症…     

23例不典型肺结核X线特征分析

目的：探讨不典型肺结核的X线表现特征,提高其诊断准确率,减少误诊率。材料与方法：回顾性分析23例不典型肺结核的X线表现特征。结果：23例不典型肺结核中右肺中下叶结核13例,慢性粟粒型肺结核2例,左肺继发型结核合并空洞1例,左肺下叶结核5例,两肺中下叶结核2例。结论：不典型肺结核X线表现不典型,临床表现复杂多样,普放工作者应提高对不典型肺结核的X线特征的认识,以减少误诊率,提高诊断准确率。     

鼻内窥镜下鼻咽粘膜非典型增生切除术后的鼻咽粘膜病理形态学观察

了解鼻咽粘膜非典型增生病变经鼻内窥镜手术切除后的病理转归,从而为鼻内窥镜手术治疗鼻咽粘膜非典型病变进而阻断鼻咽癌发生提供理论依据,方法：对20例鼻咽粘膜非典型增生患者行鼻内窥镜下鼻咽粘膜切除术,术前及术后4个月分别行鼻咽照相和病理活检,观察其组织形态变化,结果：20例患者术后鼻咽粘膜从大体形态及组织形态上恢复正常,结论：鼻咽粘膜非典型增生经手术切除后可恢复正常,而鼻内窥镜手术是治疗此类患者的有效方法。     

纤维支气管镜床边支气管肺泡冲洗治疗肺部感染

我院自 2 0 0 1年 1月～ 2 0 0 2年 1 1月对各种不同疾病并肺部感染的危重病人 ,除常规全身用药外 ,行床边纤维支气管镜 (便携式 )支气管肺泡冲洗(BL)组和对照组进行随机抽样分组 ,探讨BL对各种不同疾病并肺部感染的疗效。1　对象与方法1 .1　对象全部病例均为住院患者 ,筛选符合条件者 ,采用掷币法随机分为治疗组和对照组。治疗组 41例 :男2 7例 ,女 1 4例 ,年龄 2 1～ 76岁。其原发病分别为 :慢性支气管炎并呼吸衰竭 2 1例 ,脑部手术后 3例 ,脑血管意外昏迷 1 1例 ,全身烧伤 2例 ,胸部手术后3例 ,多发性骨折 1例 ;对照组 3 9例 :其中男 …     

肺曲菌病的影像学表现与病理联系

目的：探讨肺曲菌病的影像学表现。方法：对11例经病理及临床证实为肺曲菌病的影像学、临床及手术病理资料进行回顾性分析。结果：肺曲菌病的X线及CT主要征象包括渗出性病变(7／11)、薄壁空洞形成(7／11)可伴“球中球”征象(3／11)、多发结节(5／11)、肿块样浸润灶伴“晕轮征”(2／11)。结论：肺曲菌病的影像学表现多种多样，但认识其在不同时期具有某些特点的征象，有利于临床早期正确诊断并进行治疗。     

心尖肥厚型心肌病的超声心动图及心电图特点

随着可采用的检测手段的增多,临床对肥厚型心肌病的一个特殊类型——心尖肥厚型心肌病(AH CM)的诊断率明显提高。本组总结12例AH CM患者的相关资料,报道如下。资料与方法一、一般资料1996年1月～2004年12月经临床确诊为AH CM的患者12例,其中男10例,女2例,年龄32～64岁,平均年龄     

侵袭性肺曲菌病一例及文献复习

目的:提高对侵袭性肺曲菌病(IPA)的临床、胸部影像学、诊断和治疗的认识。方法:结合有关文献对1例经电子支气管镜活检证实的IPA患者的临床资料进行分析。结果:胸片示:两肺野见片状、斑片状模糊影,其中可见透光区;电子支气管镜检查示:双侧支气管各叶段开口大量白色坏死物附着,以右下叶背段为主,黏膜充血水肿,未见出血及新生物;病理检查示:少量黏膜及坏死组织,周围见曲菌菌丝及孢子体,黏膜上皮显著增生。经治疗后,患者好转出院。结论:IPA是一种机会性感染的肺真菌病,无特异性的临床表现,影像学表现亦无特异性,支气管镜检查对IPA有诊断价值,IPA应早期治疗。     

Therapy of Murine Pulmonary Aspergillosis with Antibody-Alliinase Conjugates and Alliin

Aspergillus fumigatus is an opportunistic fungal pathogen responsible for invasive aspergillosis in immunocompromised individuals. The high morbidity and mortality rates as well as the poor efficacy of antifungal agents remain major clinical concerns. Allicin (diallyl-dithiosulfinate), which is produced by the garlic enzyme alliinase from the harmless substrate alliin, has been shown to have wide-range antifungal specificity. A monoclonal antibody (MAb) against A. fumigatus was produced and chemically ligated to the enzyme alliinase. The purified antibody-alliinase conjugate bound to conidia and hyphae of A. fumigatus at nanomolar concentrations. In the presence of alliin, the conjugate produced cytotoxic allicin molecules, which killed the fungus. In vivo testing of the therapeutical potential of the conjugate was carried out in immunosuppressed mice infected intranasally with conidia of A. fumigatus. Intratracheal (i.t.) instillation of the conjugate and alliin (four treatments) resulted in 80 to 85% animal survival (36 days), with almost complete fungal clearance. Repetitive intratracheal administration of the conjugate and alliin was also effective when treatments were initiated at a more advanced stage of infection (50 h). The fungi were killed specifically without causing damage to the lung tissue or overt discomfort to the animals. Intratracheal instillation of the conjugate without alliin or of the unconjugated monoclonal antibody significantly delayed the death of the infected mice, but only 20% of the animals survived. A limitation of this study is that the demonstration was achieved in a constrained setting. Other routes of drug delivery will be investigated for the treatment of pulmonary and extrapulmonary aspergillosis.Aspergillus fumigatus is an opportunistic fungal pathogen that is responsible for invasive aspergillosis (IA) in immunocompromised individuals (19, 22, 25). Patients with hematological or solid malignancies, as well as organ transplant recipients, are particularly vulnerable to infection. Pulmonary infection by A. fumigatus airborne conidia is the predominant cause of IA (22). Despite advances in early diagnosis and new antifungal agents, IA currently remains a leading cause of death in the immunocompromised patient population, with an attributable mortality rate ranging from 30% to 80% (13, 50).Allicin (diallyl-dithiosulfinate), the biologically active molecule of garlic, has been shown to have a very wide range of antimicrobial activities and contributes to the defense of the garlic plant against soil microorganisms (1, 11, 15, 20, 29, 36, 44). Allicin is produced by the catalytic reaction of the enzyme alliinase (EC 4.4.1.4) with the inert, nonprotein amino acid substrate alliin [(+)-S-allyl-cysteine sulfoxide]. Crushing the garlic clove breaks down the compartmentalization and brings the enzyme and its substrate into contact, leading to allicin production (20, 30). The potential use of pure allicin as an anti-Aspergillus agent in vivo was shown in our previous work (44). Despite its short half-life, five repetitive doses of pure allicin administered intravenously (i.v.) to mice infected with A. fumigatus significantly prolonged their survival. The delivery of allicin, however, remains a major concern, due to its instability in blood circulation. Allicin rapidly transforms into secondary products that lack antimicrobial activity following intravenous injection (14, 20, 37).Our novel approach for antifungal therapy overcomes this problem by generating the production of allicin on the targeted pathogen. In a previous investigation, we developed a system of targeted production of allicin to kill specifically cancer cells (3, 27). In the present study, the potential efficacy of this novel in vivo treatment was investigated with a murine model of invasive pulmonary aspergillosis (IPA) (54). We prepared a conjugate consisting of the alliinase enzyme ligated to a monoclonal anti-A. fumigatus antibody to target the production of allicin molecules to the surface of the fungus. After infection, the conjugate and then the substrate alliin were repeatedly administered by intratracheal (i.t.) instillation as described previously (17). The main advantages of this approach over other antibody-directed enzyme prodrug therapy (ADEPT) systems (4) are (i) the harmless nature of the prodrug alliin, a natural food component that has been declared by the FDA as a substance that is generally recognized as safe (GRAS) and that can be administered in unlimited amounts and (ii) the fact that the hydrophobic allicin molecules produced on the target cell have a limited area of effect; due to their high reactivity and short lifetime, they kill the fungi without causing visible damage to the adjacent lung epithelial cells. To the best of our knowledge, this work constitutes the first example of a targeted allicin generation system for antimicrobial treatment.(This work was presented in part at the Annual Meeting of the Israel Society of Microbiology, Bar Ilan University, Ramat Gan, Israel, 5 March 2009.)     

侵袭性肺曲霉病的临床特征分析

目的:探讨侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的临床特征。方法:回顾分析83例IPA患者的临床及影像学资料。结果:IPA患者的主要临床表现为发热、咳嗽、咳痰、喘息、呼吸困难、咯血。IPA患者的影像学表现多样,典型表现如晕征和新月征则较少见(主要见于免疫抑制患者)。83例中原发性IPA患者18例,均治愈;继发性IPA患者65例,治愈23例,好转出院25例,患者要求出院12例,病死5例。结论:IPA好发于有基础疾病和免疫抑制的患者,其临床和影像学表现不典型;原发性IPA较继发性IPA预后好。