目的 探讨肺奴卡菌病的临床特点,提高临床医师对肺奴卡菌病的认识.方法 入选解放军总医院及海南分院2009年8月至2016年6月收治的13例临床标本培养为奴卡菌的患者临床资料,进行回顾性分析,总结其临床特点,并复习相关文献.结果 13例肺奴卡菌病患者中12例有基础疾病,其中7例曾应用激素和(或)免疫抑制剂.咳嗽是最常见的症状(84.6%).肺部影像学主要表现为结节影/肿块影11例(84.6%),表现为实变影9例(69.2%),表现为空洞8例(61.5%).11例(84.6%)患者首诊时被误诊,出现多器官播散患者死亡率高.以磺胺为基础的联合治疗效果较好.结论 肺奴卡菌病的临床表现缺乏特异性,容易漏诊及延误诊断,多器官播散的患者预后差.对有易感因素的患者,常规治疗效果不佳时,需考虑本病的可能.%Objective To investigate the clinical characteristics of pulmonary nocardiosis in order to improve its awareness for physicians .Methods Clinical data of 13 pulmonary nocardiosis patients admitted in our hospital and the Hainan Branch of our hospital from August 2009 to June 2016 were collected and retrospectively analyzed .Clinical characteristics were summarized and relevant literature was reviewed .Results There were 12 out of 13 patients having underlying diseases , and 7 patients had received corticoste-roid and/or immunosuppressive agents .Cough was the most common symptom (84.6%).Radiological findings showed that 11 cases (84.6%) were manifested as lung nodules/masses, 9 (69.2%) as consolidation, and 8 as cavitary lesions (61.5%).Among them, 84.6%were misdiagnosed initially .The mortality was quite high in those with multiple organ dissemination .Combination therapy based on sulfanilamide resulted in sound clinical outcomes .Conclusion Pulmonary nocardiosis has no specific clinical manifestations , and its diagnosis can be frequently missed or delayed .The patients with multiple organs dissemination involved have poor prognosis .So for the patients having susceptible factors , this disease should be considered when conventional therapy is not effective .
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