Objective: To analyze the clinical characteristics of patients with pulmonary mucormycosis treated with and without surgery. Methods: This was a single-center, retrospective study. We retrieved "pulmonary mucormycosis" from the electronic medical records of China-Japan Friendship Hospital between 2016 and 2022. A total of 29 patients with pulmonary mucormycosis were collected. There were 19 males and 10 females with a median age of 49 (47, 67) years. Mann-Whitney U test, χ² test, Kaplan-Meier curve and log-rank test were used to compare the differences between groups. Results: The most common underlying disease was diabetes (19, 65.5%). The most frequent imaging findings were consolidation (25, 86.2%) and nodule or mass (21, 72.4%). Bronchial stenosis (16, 55.2%), obstruction by fungal plugs (18, 62.1%), pseudomembranous necrotizing bronchitis (19, 65.5%) were common. Treatment strategies were developed by the multi-disciplinary team (MDT). Among 16 patients who did not undergo surgery, 10 had bilateral multifocal lesions and 6 had unifocal lesions. All patients received antifungal therapies, and surgeries were performed in 13 (44.8%) patients. Patients who underwent surgery had numerically lower in-hospital mortality (15.4% vs. 31.3%, P=0.410). Involvement of unilateral multiple lesions was more common in patients who underwent surgeries (6/13 vs. 1/16, P=0.019). Patients who underwent surgery were more likely to have lobar and segmental bronchial involvement (13/13 vs. 9/16, P=0.007). A total of 15 patients underwent mNGS, 14 (93.3%) had positive results. Performing metagenomic next generation sequencing for diagnosis shortened the time from disease onset to diagnosis (log-rank P=0.014). Conclusion: Metagenomic next-generation sequencing aided early diagnosis. The patients who underwent surgery included unilateral multiple lesions and visualisation of endobronchial abnormalities on lobar or segmental bronchus in unilateral lung.
目的： 分析接受手术治疗与未手术的肺毛霉病患者的临床特征。 方法： 单中心回顾性研究。从中日友好医院电子病历系统中检索“肺毛霉病”，纳入 2016年7月—2022年6月的肺毛霉病患者29例，其中男19例，女10例，中位年龄49（47，67）岁。采用Mann-Whitney U检验、χ²检验、Kaplan-Meier曲线和log-rank检验比较组间差异。 结果： 肺毛霉病患者最常见的基础疾病是糖尿病（19例，65.5%），影像学表现以实变（25，86.2%）、结节或肿块（21例，72.4%）最常见，气管镜检查可见支气管狭窄（16例，55.2%）、真菌菌栓阻塞支气管开口（18例，62.1%）、支气管黏膜表面覆盖坏死物（19例，65.5%）等异常表现。所有患者均接受抗真菌药物治疗，13例（44.8%）患者接受手术治疗。患者是否手术由多学科团队（MDT）进行评估，16例未手术患者中有10例为双侧多发病灶、其中4例累及主支气管而无法切除，6例为单个肺叶内局限病灶。接受手术治疗的患者与未手术的患者相比，单侧肺多个病灶者（6/13比1/16，P=0.019）及叶、段支气管受累者（13/13比9/16，P=0.007）更常见。15例患者行宏基因组二代测序（mNGS），其中14例为阳性结果。进行mNGS检查缩短了从发病到诊断的时间（log-rank P=0.014）。接受手术治疗的患者院内病死率较低，但差异无统计学意义（2/13比5/16，P=0.410）。 结论： mNGS有助于肺毛霉病早期诊断。接受手术治疗患者的特征包括单侧多发病灶和支气管镜检叶、段支气管黏膜病变。.