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肺曲霉菌病的外科治疗

目的探讨肺曲霉菌病的临床特点与外科治疗原则。方法回顾分析32例肺曲霉菌病患者的临床资料和手术治疗结果，手术施行采用标准后外侧切口肺叶切除术6例，楔形切除术3例，胸腔镜或胸腔镜辅助改良后外侧微创小切口楔形切除术15例，肺叶切除术6例，肺段切除术2例。结果21例无肺原发疾病，11例有肺原发疾病。痰菌检查阳性率为13．3％（2／15），术前诊断符合率为28．1％（9／32）；术后并发症发生率为15．6％（5／32），其中切口皮下积液、肺膨胀不良各2例，气胸1例；随访32例，随访10～160个月，无咯血或血痰、肺曲霉菌病复发或播散。结论肺曲霉菌病多数无肺原发疾病和症状，无论有否症状均应手术治疗，而微创外科手术治疗并发症少且较轻，是首选的治疗方法。

Interferon Therapy for Mycosis Fungoides: A Systematic Review

【摘要】　目的　采用系统评价方法，评估干扰素（IFN）治疗蕈样霉菌病（MF）的疗效及安全性。　方法　计算机检索截止2010年5月的Cochrane协作网系统评价方法，纳入所有比较IFN与其他方法治疗MF的随机对照试验及临床对照试验进行质量评价，采用RevMan 5.0.24软件进行Meta分析。　结果　共纳入6篇符合标准的已发表文献，包括142例受试者。Meta分析结果显示: IFN-α单独使用对MF的疗效优于安慰剂组[OR=69.36，95%CI（3.71～1 296.64）]及地精丹方剂[OR=35.53，95%CI（1.78～710.56）]；而IFN-α与胸腺肽[OR=15.11，95%CI（0.71～322.61）]及IFN-α+阿维A酯[OR=3.10，95%CI（0.79～12.12）]的临床疗效差异无统计学意义；IFN-γ联合窄谱中波紫外线（NB-UVB）治疗与单用NB-UVB的临床疗效差异无统计学意义[OR=15.00，95%CI （0.46～485.32）]。90%的患者出现轻度“流感样症状” 的不良反应，多可缓解及消退。　结论　IFN是目前治疗MF的一线用药，疗效确切且大部分患者耐受性较好。【Abstract】　Objective　To evaluate the clinical efficacy and side effects of interferon (IFN) in the treatment of mycosis fungoides (MF) with the method of systematic review. 　Methods　According to the Cochrane reviewer’s handbook, all the clinical controlled trials involving mycosis fungoides being treated with interferon were retrieved. The Cochrane Collaboration’s software RevMan 5.0.24 was used for meta-analysis.　Results　Only six papers including 142 patients met the inclusion criteria. Meta-analyses indicated the results as follows: IFN-α monotherapy was more effective than placebo [OR=69.36,95% CI (3.71-1 296.64)] and a traditional Chinese medicine (Di-jing-dan) [OR=35.53,95% CI (1.78-710.56)], but no significant difference was found between INF-α and thymic peptide [OR=15.11, 95% CI (0.71-322.61)], and between IFN-α monotherapy and IFN-α combined with etretinate therapy [OR=3.10, 95% CI (0.79-12.12)]; and there was no significant difference between the efficacy of IFN-γ combined narrowband ultraviolet B (NB-UVB) therapy and that of single NB-UVB therapy [OR=15.00, 95% CI (0.46-485.32)]; Influenza-like side effects occurred to 90% of all the patients, which were usually slight and easy to release.　Conclusion　Although there are some mild side effects, interferon is safe to treat MF.

Infection Rate of Acquired Immune Deficiency Syndrome Disease Combined with Penicillium Marneffei Laboratory Test Results and Analysis of Susceptibility

目的 探究艾滋病(AIDS)合并马尔尼菲青霉病(PSM)的感染率，以及常规实验室检查结果和5种抗真菌药物对马尔尼菲青霉菌(PM)的体外抗菌活性。 方法 2006年1月-2009年11月间确诊AIDS患者326例，从其血液、骨髓培养出65株PM，检测该65例患者的血常规、肝功能和肾功能，并对20株酵母相PM进行体外药敏进行分析。 结果 AIDS合并PSM的感染率为19.94%；外周血常规：WBClt;4.0×109/L者48例，HBlt;100 g/L者51例，PLTlt;100×109/L者46例。肝功能检查：ALTgt;40 U/L者49，ASTgt;40 U/L者51例，GGTgt;60 U/L者44例，ALPgt;150 U/L者36例，ALBlt;35 g/L者53例，A/G倒置者50例。肾功能检查：BUNgt;7.2 mmol/L者9例，Crgt;150 μmol/L者4例。20株酵母相PM对5-氟胞嘧啶(5FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分别为75%、90%、80%、90%、90%。 结论 AIDS合并PSM感染率较高；患者感染后外周血WBC、HB、PLT通常低于正常人，肝功能多表现异常，肾功能的改变较少；对PM的治疗以AMB、ITR、VRC为首选。

侵袭性肺迟缓曲霉病一例报道

目的 通过本病例及综述以提升对侵袭性肺迟缓曲霉病早期病原学诊断的重视，并为治疗方案提供参考依据。方法 回顾我科诊治的1例COVID-19感染后继发的侵袭性肺迟缓曲霉病患者的临床资料，复习既往文献总结分析肺迟缓曲霉病的临床表现、诊断及治疗用药方案。结果 患者79岁，老年男性，咳嗽、咳痰伴呼吸困难4月余。胸部CT提示：双肺数个结节灶，部分结节内空洞形成；散在实变影。G实验、GM结果阴性。气管镜肺泡灌洗液送检mNGS查见迟缓曲霉菌。给予伏立康唑治疗后效不佳，且继发肝功能异常，调整为艾沙康唑治疗后临床症状及肺部影像学征象好转。复习文献，共有12例个案报道，其中8例存在免疫抑制状态，4例合并慢性阻塞性肺病，6例为器官移植术后。临床选药以伏立康唑和两性霉素B居多，虽经治疗仍有66.7%（8例）患者在确诊后7周内死亡。结论 本例为国内外首次使用艾沙康唑成功治疗侵袭性肺迟缓曲霉病的报告。侵袭性肺迟缓曲霉病属于罕见病，免疫抑制状态是其高危因素。该病进展迅速，具有高度耐药性，预后差，病死率高，早期病原学诊断尤为关键。

全肺切除治疗肺毛霉菌病合并肺脓肿一例并文献复习

目的 探讨侵袭性支气管肺毛霉菌病合并毛霉菌肺脓肿内科治疗无效时外科手术的可行性。方法 报告1例2022年在解放军总医院第八医学中心住院的支气管肺毛霉菌病合并毛霉菌肺脓肿患者内科治疗及外科手术过程，并对外科手术在肺毛霉菌病治疗中的有关文献进行复习。结果 患者男性，29岁，某药厂排污厂房工人，既往患有糖尿病。因咳嗽，咳痰，咯血40余天，高热5天入院。经支气管镜活检诊断为左主支气管毛霉菌病，积极内科治疗无效时，行左全肺切除术，术后治愈出院。术后病理示支气管肺毛霉菌病并左下肺毛霉菌肺脓肿。文献复习显示外科手术是支气管肺毛霉菌病治疗手段之一，但目前肺毛霉菌病手术治疗多限于单纯孤立病灶和肺叶切除术，全肺切除术罕见。未检索到类似本例全肺切除治愈支气管肺毛霉菌病，毛霉菌肺脓肿的报告。结论 侵袭性支气管肺毛霉菌病，合并毛霉菌肺脓肿在内科治疗无效时，外科手术治疗亦应值得考虑。

Clinical characteristics of patients with Coronavirus Disease 2019-associated pulmonary mucormycosis

ObjectiveTo analyze the clinical characteristics, prognosis and predisposing factors of coronavirus disease 2019 (COVID-19) associated pulmonary mucormycosis (CAPM), so as to improve people's understanding of the disease.MethodsFrom from September 1, 2021 to July 31, 2024, 11 patients with CAPM who were hospitalized in Beijing Chaoyang Hospital affiliated to Capital Medical University were retrospectively collected, and 22 patients with non-CAPM were included after matching according to the ratio of 1:2. The clinical manifestations, laboratory examinations, imaging features, tracheoscopy, treatment and prognosis of the two groups were analyzed. ResultsThe average age of patients in CAPM group was 59.5 ± 10.6 years, with 81.8% of males; diabetes mellitus (90.9%) was the most common complication. In CAPM group, the median time after the occurrence of mucor after COVID-19 was 13.0 (10.0, 24.0) days. The utilization rate of glucocorticoids in the CAPM group was 63.6% (7/11), which was significantly higher than that in non-CAPM group [13.6% (3/22)], and the difference between the groups was statistically significant (P=0.006). The C-reactive protein level in CAPM group was significantly higher at 93.90 (75.00, 129.00) mg/L than that in non-CAPM group at 26.10 (4.83, 114.03) mg/L, with a statistically significant difference (P=0.040). The CD4+T lymphocyte counts and B lymphocyte counts in CAPM group were 223.00 (66.75, 336.75)/µL and 32.00 (21.75, 55.25)/µL, respectively, which were significantly lower than those in the non-CAPM group 394.00 (206.00, 610.00)/µL and 112.50 (56.00, 159.25)/µL, with statistical differences between the groups (P=0.040, P=0.040). In terms of imaging, the main imaging findings were the involvement of multiple lobes in both groups. 63.6% (7/11) of patients with pulmonary aspergillosis in CAPM group were significantly higher than those(4/22, 18.2%) in non-CAPM group (P=0.017). The incidence of dyspnea in CAPM group was significantly higher than that in non-CAPM group (90.9% vs. 50.0%, 0.027%).ConclusionThe proportion of glucocorticoid use and the proportion of pulmonary aspergillosis in CAPM group are significantly higher, and they are in a more serious state of immunosuppression. Once combined with pulmonary aspergillus , the mortality rate is higher.

眶内霉菌感染一例并文献复习

【摘要】　目的　报道眶内霉菌感染一例。　方法　2011年3月4日收治1例眶内霉菌感染患者，结合文献分析其临床特点及诊治方法。　结果　患者为47岁女性，有霉菌性鼻窦炎病史，右眼肿胀、视物模糊。经抗真菌治疗，病情稳定出院；后多次复发入院，且出现肝肾功能损害。经抗真菌、保肝、保肾、对症治疗，病情稳定出院。　结论　眶内霉菌感染多系鼻窦炎扩散而来，易复发，疗程较长，治疗过程中应监测肝肾功能。

无哮喘的变应性支气管肺曲霉病一例

目的 报道并分析1例变应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的临床特点、诊断及治疗方法。方法 结合文献资料分析我科2019年诊治的1例ABPA的病例。结果 该患者诊断明确，治疗稍有曲折。ABPA常发生于肺部有基础疾病者，尤其是支气管哮喘或囊性纤维化者。临床表现主要是咳嗽、咳痰、喘息、胸闷；实验室检查血清总IgE水平和曲霉特异性IgE水平上升，以及嗜酸性粒细胞数增加；胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和抗真菌治疗，对于不能耐受糖皮质激素的患者，抗IgE抗体治疗有益。结论 临床上ABPA容易误诊、误治，特别是无哮喘病史时，其诊断更加困难。因此早期诊断和正确治疗可以减少ABPA造成的肺损伤，改善患者的预后。

狼疮性肾炎合并肺部多重真菌感染一例

Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

ObjectiveTo discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. MethodsWe retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group (open group, n=11) and a video-assisted thoracoscope pneumonectomy group (VATS group, n=28). There were 8 male patients and 3 female patients with age of 29-64 (50.7±9.7) years in the open group. There were 13 male patients and 15 female patients with age of 20-75 (55.4±15.3) years in the VATS group. We compared clinical effectiveness between the two groups. ResultsThe operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time (P=0.001), the loss of intraoperative blood (P=0.005), and the score of pain (P=0.001). There was no statistical difference in lead flow of postoperative chest (P>0.05) and the time of hospitalization (P>0.05). ConclusionVideo-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization．