肺諾卡菌病的臨床特征分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

李文俊 , 鄭艾波 , 古麗 , 陳治宇 , 沈奕播 , 馬升軍 ,  孫楷

自貢市第四人民醫院呼吸與危重癥醫學科（四川自貢 643000）;

Corresponding?author：

孫楷, Email: 26576628@qq.com

Keywords：

諾卡菌; 肺部感染; 臨床特征

DOI：

10.7507/1671-6205.202508023

Video：

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目的分析肺諾卡菌病的臨床特征，提高對此病的認識。方法回顧性分析自貢市第四人民醫院2020年1月—2025年1月收治的肺諾卡菌病患者的臨床癥狀、感染菌種、影像學檢查、治療方案與預后等資料，總結其臨床特征。結果共納入19例患者，平均年齡（67.84±11.27）歲，癥狀以咳嗽（18例）、咳痰（14例）為主。14例（73.7%）患者有基礎疾病，10例（52.6%）有支氣管擴張癥，7例（36.8%）有慢性阻塞性肺疾病。14例（73.7%）患者診斷依靠宏基因組二代測序（metagenomic next-generation sequencing，mNGS），痰培養陽性率31.6%（6例），支氣管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）培養陽性率31.3%（5例）。檢出6種諾卡菌，圣喬治教堂諾卡菌占比36.8%（7例），皮疽諾卡菌占比26.3%（5例）。68.4%（13例）的患者合并其他病原體感染，其中銅綠假單胞菌（6例）最常見。胸部CT以斑片影（9例）、實變（7例）及空洞（5例）最常見。18例患者接受復方磺胺甲噁唑治療，預后較好。結論肺諾卡菌病好發于存在肺結構性改變的患者，常合并其他病原體感染，其臨床癥狀、胸部CT無特異性，痰培養陽性率低，BALF送檢mNGS有助于提高診斷率，復方磺胺甲噁唑治療效果好。

Citation： 李文俊, 鄭艾波, 古麗, 陳治宇, 沈奕播, 馬升軍, 孫楷. 肺諾卡菌病的臨床特征分析. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(11): 807-809. doi: 10.7507/1671-6205.202508023 Copy

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10.	毛雅云, 陳磊, 翁恒. 肺諾卡菌病25例臨床特征分析. 中國感染與化療雜志, 2020, 20(6): 5.
11.	夏宇, 考吾沙爾·巴合提江. 應用宏基因組二代測序技術分析慢性阻塞性肺疾病患者合并下呼吸道感染的BALF中微生物群落分布和載量. 中國呼吸與危重監護雜志, 2024, 23(6): 414-422.
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14.	連璐璐, 萬康林, 姜元, 等. 44株甘肅疑似非結核分枝桿菌臨床分離株的菌種鑒定. 中國人獸共患病學報, 2013, 29(4): 6.
15.	韓李周, 李德保, 雷莉娜, 等. 變應性支氣管肺曲霉病合并肺諾卡菌感染一例并文獻復習. 中國呼吸與危重監護雜志, 2022, 21(11): 810-814.
16.	劉利華, 李釗, 李曉哲, 等. 豚鼠耳炎諾卡菌合并曲霉感染一例. 中國呼吸與危重監護雜志, 2019, 18(2): 179-181.
17.	任潔, 湯榮, 楊鍇, 等. 新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核一例并文獻復習. 中國呼吸與危重監護雜志, 2024, 23(7): 504-508.
18.	金文芳, 姚羽, 許菲. 15例肺諾卡菌病的臨床特征. 中國感染控制雜志, 2023, 22(5): 574-580.
19.	戴維·吉爾伯特, 亨利·錢伯斯, 邁克爾·薩格, 等. 桑福德抗微生物治療指南. 第50版. 北京: 中國協和醫科大學出版社, 2020, 45.
20.	Restrepo A, Clark NM. Nocardia infections in solid organ transplantation: guidelines from the infectious diseases community of practice of the American society of transplantation. Clin Transplant, 2019, 33(9): e13509.
21.	Anagnostou T, Arvanitis M, Kourkoumpetis TK, et al. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore), 2014, 93(1): 19-32.

1. Singh S, Verma Y, Pandey P, et al. Granulomatous hepatitis by nocardia species: an unusual case. Int J Infect Dis, 2019, 81: 97-99.
2. 劉加夫, 林清華, 陳友軒, 等. 奴卡菌肺炎4例臨床病理學觀察. 臨床與實驗病理學雜志, 2023, 39(5): 620-622.
3. Traxler RM, Bell ME, Lasker B, et al. Updated review on nocardia species: 2006-2021. Clin Microbiol Rev, 2022, 35(4): e2721.
4. Wang H, Zhu Y, Cui Q, et al. Epidemiology and antimicrobial resistance profiles of the nocardia species in China, 2009 to 2021. Microbiol Spectr, 2022, 10(2): e156021.
5. Elhassan MM. Nocardiosis in Sudan: current situation and future perspective. Infect Disord Drug Targets, 2019, 19(2): 105-112.
6. Esnault V, Wittnebel S, Pouillon M, et al. Thyroid nocardiosis: case report and review of the literature. Transpl Infect Dis, 2021, 23(4): e13594.
7. Wang C, Sun Q, Yan J, et al. The species distribution and antimicrobial resistance profiles of nocardia species in China: A systematic review and meta-analysis. PLoS Negl Trop Dis, 2023, 17(7): e11432.
8. Hamdi AM, Fida M, Deml SM, et al. Retrospective analysis of antimicrobial susceptibility profiles of nocardia species from a tertiary hospital and reference laboratory, 2011 to 2017. Antimicrob Agents Chemother, 2020, 64(3): e01868-19.
9. 韓云港, 韓俊壘, 陳會會, 等. 42例肺諾卡菌病患者的臨床特征及其病原菌耐藥性. 中國感染控制雜志, 2022, 21(7): 668-674.
10. 毛雅云, 陳磊, 翁恒. 肺諾卡菌病25例臨床特征分析. 中國感染與化療雜志, 2020, 20(6): 5.
11. 夏宇, 考吾沙爾·巴合提江. 應用宏基因組二代測序技術分析慢性阻塞性肺疾病患者合并下呼吸道感染的BALF中微生物群落分布和載量. 中國呼吸與危重監護雜志, 2024, 23(6): 414-422.
12. Zhong C, Huang P, Zhan Y, et al. Clinical features of pulmonary nocardiosis in patients with different underlying diseases: a case series study. Infect Drug Resist, 2022, 15: 1167-1174.
13. Dong G, Chu P, Guo J, et al. Nontuberculous mycobacterial and nocardia infections mimicking pulmonary tuberculosis: a retrospective study of a general hospital patient population in China. J Med Microbiol, 2020, 69(9): 1145-1150.
14. 連璐璐, 萬康林, 姜元, 等. 44株甘肅疑似非結核分枝桿菌臨床分離株的菌種鑒定. 中國人獸共患病學報, 2013, 29(4): 6.
15. 韓李周, 李德保, 雷莉娜, 等. 變應性支氣管肺曲霉病合并肺諾卡菌感染一例并文獻復習. 中國呼吸與危重監護雜志, 2022, 21(11): 810-814.
16. 劉利華, 李釗, 李曉哲, 等. 豚鼠耳炎諾卡菌合并曲霉感染一例. 中國呼吸與危重監護雜志, 2019, 18(2): 179-181.
17. 任潔, 湯榮, 楊鍇, 等. 新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核一例并文獻復習. 中國呼吸與危重監護雜志, 2024, 23(7): 504-508.
18. 金文芳, 姚羽, 許菲. 15例肺諾卡菌病的臨床特征. 中國感染控制雜志, 2023, 22(5): 574-580.
19. 戴維·吉爾伯特, 亨利·錢伯斯, 邁克爾·薩格, 等. 桑福德抗微生物治療指南. 第50版. 北京: 中國協和醫科大學出版社, 2020, 45.
20. Restrepo A, Clark NM. Nocardia infections in solid organ transplantation: guidelines from the infectious diseases community of practice of the American society of transplantation. Clin Transplant, 2019, 33(9): e13509.
21. Anagnostou T, Arvanitis M, Kourkoumpetis TK, et al. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore), 2014, 93(1): 19-32.

Chinese Journal of Respiratory and Critical Care Medicine

肺諾卡菌病的臨床特征分析

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