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find Author "杨晓娅" 5 results
  • 胸腔子宫内膜异位症致血性胸腔积液一例并文献复习

    目的 拓展血性胸腔积液的鉴别诊断范畴,加深临床医师对胸腔子宫内膜异位症的认识,为其诊断、治疗提供有价值的参考。方法 报道1例罕见的胸腔子宫内膜异位症致血性胸腔积液患者的诊治经过,并在PubMed数据库以胸腔子宫内膜异位症为关键词进行文献检索予以文献复习。结果 该患者血性胸腔积液于外院初诊为癌性胸腔积液,入院后经胸腔镜获取病理组织行病理活检和免疫组织化后明确诊断为胸腔子宫内膜异位症,通过胸腔置管引流及促性腺激素释放激素类似物治疗后目前随访3个月暂未见复发。检索相关文献发现,胸腔子宫内膜异位症导致血性胸腔积液患者临床罕见,发病机制不明确,缺乏特异的症状及影像学特征,其诊断需基于临床表现、影像学及病理活检,治疗需依据病情合理选择药物及手术,但该病复发率较高。结论 胸腔子宫内膜异位症为胸腔积液的罕见病因,需加深对其认识避免误诊及漏诊,对于症状与月经周期存在时间关系、右侧胸腔病变、育龄期女性、病情反复的患者临床需谨慎排除。

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  • A case of hypersensitivity pneumonitis presenting as progressive fibrotic interstitial lung disease and literature review

    ObjectiveTo strengthen the understanding to hypersensitivity pneumonitis and make early diagnosis and standard treatment by analyzing the clinical features, the diagnosis and treatment of a patient diagnosed as hypersensitivity pneumonitis presenting as progressive fibrotic interstitial lung disease in combination with literature review.MethodsThe diagnosis and treatment process and relevant clinical data of the patient were analyzed retrospectively and literatures were reviewed. Based on 282 relevant literatures, the diagnostic methods, treatment and prognostic factors of hypersensitivity pneumonitis were summarized.ResultsThe patient, female, 45 years old, self-employed, was admitted to the hospital due to "cough, sputum for 9 years, dyspnea for more than 6 months" without obvious extrapulmonary clinical manifestations. Creaks at the bottom of the lungs and clubbed toes were found through physical examination. High-resolution computed tomography indicated that the main manifestations were ground glass and grid-like shadows, presenting characteristics of interstitial pneumonia. The pulmonary lesions aggravated gradually, and part of the lung lobe presented honeycomb lung at the time of diagnosis. Eight years ago, she performed fibrobronchoscopy in other hospital revealing an increased lymphocyte proportion (39%) in bronchoalveolar lavage fluid. Lung function suggested very severe restrictive ventilation dysfunction. She was given prednisone for a short time, and the drug was stopped by herself with uncertain efficacy. Later, she performed frozen lung biopsy suggesting peribronchiolar metaplasia interstitial broadening with lymphocytic infiltration, without granuloma or fibroblast lesions. No obvious abnormity was seen in makers of infections and immunology. At this point, the patient was clearly diagnosed as hypersensitivity pneumonitis. Meanwhile, the patient's pulmonary lesions were still mainly made of ground glass and plaques, partly with changes like honeycomb. Poor response was obtained with anti-inflammatory treatment of prednisone for 3 months and anti-fibrosis treatment of pirfenidon for more than 2 months. Literature review resulted in 87 patients, including 39 males (44.82%) and 48 females (55.18%), with an average age of (47.0±18.4) years. Seventy patients (80.46%) had clear allergens. 3.45% patients' lymphocyte percentage in bronchoalveolar lavage fluid ranged from 20% to 39%, and 19.54% patients' lymphocyte percentage was more than 40%. 4.60% of the patients achieved remission through detachment from allergens; 71.27% of the patients achieved remission with glucocorticoid treatment, 14.94% improved with glucocorticoid treatment, and 1.15% died; 6.89% of the patients achieved remission after receiving anti-allergy therapy. Patients with chronic hypersensitivity pneumonia were found with poor prognosis.ConclusionsIn patients with diffuse interstitial pulmonary fibrosis with unknown cause, transbronchoscope freezing lung biopsy as early as possible is a feasible method for early diagnosis and improving prognosis. Patients with hypersensitivity pneumonitis with a long course of pulmonary fibrosis have a poor response to glucocorticoid and other classic treatments, and most of them have a poor prognosis.

    Release date:2021-04-25 10:17 Export PDF Favorites Scan
  • 肺放线菌病一例报告

    目的 通过分析1例肺放线菌病患者的临床特征及诊治过程,结合文献复习,加强临床医生对本病的认识,以期早期诊断、规范治疗,改善患者预后。方法 回顾性分析1例肺放线菌病患者的临床资料,以“肺放线菌病”、“放线菌肺炎”为关键词在万方数据库、中国知网数据库、中国期刊全文数据库,以“pulmonary”和“actinomycosis”为关键词在PubMed数据库检索相关文献进行文献复习,总结肺放线菌病的临床特征、影像学特点、诊断手段、治疗及预后不良相关因素。结果 患者男,53岁,因“反复咳嗽、咳痰4-个月,伴咯血15 d”入院。患者无明显肺外临床表现,内科查体未见明显异常,外院胸部CT提示左下肺团片影,两次痰液送检二代测序,均检出放线菌菌属(检出最多序列数4393),革兰阳性格雷文尼放线菌多(检出最多序列数4258)。入院后予头孢哌酮舒巴坦针静脉滴注抗感染19 d,出院后继续复方磺胺口服,随访至2021年3月患者胸部影像学提示病变已明显吸收好转。结合本例及国内外文献报道的肺放线菌病相关资料,结果显示该病中老年男性多见,口腔卫生条件不良是该病的主要危险因素,临床症状无特异性,主要表现为咳嗽、咳痰、咯血,胸部CT典型表现为团块影并空洞形成,增强后不均匀强化,病灶内见稍低密度或气体密度,经支气管活检、经皮肺穿刺或手术标本病理为主要确诊手段,近年二代测序技术已成为诊断该病的重要工具。放线菌对多种抗菌药物敏感,但抗菌药物治疗疗程长,推荐6~12个月。内科及介入无法控制的大咯血以及抗菌药物治疗长疗程前提下临床症状无缓解、胸部影像学肺部病灶无明显吸收的患者,手术可能是一种治疗选择。结论 肺放线菌病的临床特征及影像学表现均不典型,影像学上常表现为巨大团块,临床上常被误诊为肿瘤。痰液、纤维支气管镜灌洗液标本及经皮肺穿刺组织标本病原微生物二代基因测序有助于确诊。经抗菌药物治疗预后良好,对于止血药物及介入无法控制的大咯血、使用长疗程抗菌药物后临床症状仍缓解不明显或胸部影像学病变未见明显吸收的患者,手术可能是一种治疗选择。

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  • 急性肺栓塞危险分层及预后评估研究进展

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  • 宏基因组二代测序辅助诊断军团菌病伴横纹肌溶解和急性肾损伤一例

    目的 加强临床医生对军团菌病多器官损害临床特点的认识,针对目前军团菌诊断的难点,重视宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在本病诊断中的应用价值,以早期诊断与精准治疗,改善军团菌病患者的预后。方法 分析 1 例经 mNGS 确诊的嗜肺军团菌病患者的临床特点、治疗过程及预后。结果 患者男,61 岁,因“发热、咳嗽伴乏力 3 d”就诊。发病初期除呼吸道症状外,合并多系统症状。住院期间,在肺泡灌洗液及肺组织中,mNGS 检出嗜肺军团菌,结合临床特点诊断军团菌病。患者经有创呼吸、抗感染、血液透析、保肝等综合治疗后,最终顺利出院。结论 对于病程短,以肺炎表现为主伴多器官受累的疾病,尤其伴肌酸激酶显著升高者应警惕军团菌感染可能。对于病情危重且少痰或无痰的患者,在缺少其他检测方法(如军团菌尿抗原)的情况下,可行纤维支气管镜取肺泡灌洗液或经皮肺穿刺取肺组织进行mNGS检查,以早期明确病原体。军团菌肺炎伴发横纹肌溶解和急性肾损伤时,及早予以针对病因及并发症的综合治疗有助于改善患者预后。

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