| Objectives To investigate the state quo of the pulmonary fungal disease in Fujian Provincial hospital,and analyze the clinical manifestations of this disease in patients with different immune states.Methods Retrospective analysis was performed on the clinical data in patients with pulmonary fungal disease examined by pathological in Fujian Provincial hospital from June 2012 to June 2016.Patients were divided into two groups based on their disease courses,having basic disease group and having no basic disease group.The univariate analysis was used to compare the differentiation of clinical characteristics between the two groups.Then multivariate conditional analysis was introduced to reveal the independent risk of those significant clinical features.Results1.The results of the general information The pathogen of this research contains Cryptococcus(61;78.2%),Aspergillus(14;18%),Penicillium marneffei?Mucor?Trichosporon asahii(3;3.8%).Cryptococcus mostly infected healthy persons and aspergillus largely infected persons with basic diseases(P<0.05).In our research the most common basic diseases were 2-diabetes mellitus(15.4%)and cancer(12.8%).2.The results of univariate conditional analysis in clinical characteristics.(1)The clinical symptoms in healthy group were nonspecific.The group with basic diseases had significantly higher occurrence rate of hemoptysis and fever than the healthy one(P<0.05).(2)The bronchoscope performance in healthy persons was normal or nonspecific inflammation.On the contrary the other group more often had positive findings,especially neoplasm?thanatosis and tracheal constriction(P<0.05).(3)The imageology characteristics of two groups were non-differential.The lesion distributions of pulmonary fungal disease mostly appeared on right lung field,especially right inferior lobe.This feature was significantly more often seen in the group with basic diseases(P<0.05).(4)The positive rate of the inflammatory marks among the tested patients was about50% and the differences between amplitude were no statistical significance(P<0.05).(5)In this work the diagnosis methods were pneumonectomy under the thoracoscope?CT-guided percutaneous transthoracic biopsy?transbronchial lung biopsy?blood culture.The healthy patients mostly chose pneumonectomy to diagnose(51.1%),the patients with basic diseases often chose CT-guided percutaneous transthoracic biopsy(45.5%).3.Multivariate conditional analysis showed that having basic diseases was the independent risk for the hemoptysis?tracheal cavity necrosis?neoplasm?stenosis and the right lung(OR:13.719?36.000?3.41,95%CI: 1.687-111.547?3.473-373.177?1.329-8.731).4.The analysis of misdiagnosis?therapy methods and outcome:Our hospital misdiagnosis rate was about 67.9%.The therapy methods we chose were drugs?excision or combination of the two ways.In this study all patients gave priority to drug way,especially in the group with basic diseases(P<0.05).The final death toll was six patients,three of which died of disseminated fungal infection(the pathogen is aspergillus?penicillium marneffei?trichosporon asahii).Conclusions The most common pathogen chosen in this research was cryptococcus,and the second one was aspergillus.Most of the patients were healthy and acquired from community.Different pathogenic mechanism caused different clinical characteristics.The healthy patients might show nonspecific inflammation symptom,like cough and expectoration?moist rales.But the patients having basic diseases more often appeared hemoptysis?tracheal cavity necrosis?neoplasm?stenosis,and the lesion distribution was often seen at right lung.The imageology characteristics of two groups were non-differential.Furthermore the clinical doctors should find the suspected patients earlier and get the pathology or culture result earlier for definite diagnosis. |
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