造血干细胞移植后侵袭性肺曲霉病患者12例的肺功能改变

目的观察12例造血干细胞移植(HSCT)后并发侵袭性肺曲霉病(IPA)对患者肺功能参数及动脉血气的影响。方法 2007年2月~2009年10月本院接受HSCT后并发IPA患者12例,男8例,女4例,中位年龄34岁(26~67岁)。移植前后均行肺功能测试、动脉血气分析以及影像学检查。结果中位随访时间为132 d(97~432 d),无1例发生Ⅲ、Ⅳ度急性移植物抗宿主病(GVHD)。2例在移植1年后发生慢性GVHD。12例均为病理确诊或临床诊断IPA者,移植前肺功能测定仅有弥散功能轻度减退。抗真菌治疗8周后肺功能测试发现所有患者均存在不同程度的阻塞性通气障碍,其中8例患者呈小气道病变[FEF50和FEF75分别为(55.9±3.4)%和(41.9±4.1)%],4例患者则出现混合性通气障碍,总弥散量(DLCO)也显著降低[(47.4±2.9)%预计值],动脉血氧分压(PaO2)仅为(68.7±4.1)mmHg,但弥散常数(DLCO/VA)尚正常,与移植前无显著差异(P0.05)。结论 HSCT后并发IPA可对患者的肺功能造成不同程度的损害,肺内多部位感染或反复发生IPA的患者可出现较严重的混合性通气障碍,弥散也显著减退。

Abnormalities of pulmonary function in patients with invasive pulmonary aspergillosis after hematopoietic stem cell transplantation

Objective To evaluate pulmonary function abnormailites in patients infected with invasive pulmonary aspergillosis(IPA) after hematopoietic stem cell transplantation(HSCT).Methods 12 patients receiving HSCT from februrary of 2007 to 2009 were enrolled in the study(median age,34;range,26～67;8 males and 4 females).Pulmonary function test(PFT),arterial blood gas(ABG) and computed tomography(CT) scan were performed before HSCT and after antifungal therapy(≥8 weeks).Results Median follow-up time was 132 d(97～432).Acute graft versus host disease(GVHD)(Grade Ⅲ～Ⅳ) did not occur but chronic GVHD was observed in 2 patients one year later.Of the 12 patients,IPA was proven in 6 patients and probable in the others.Airflow obstruction was found in all patients.Expiratory flow limitation was mild in 8 patients[forced expiratory flow at 50% volume capacity(FEF50) and forced expiratory flow at 25% volume capacity(FEF75) were(55.9±3.4)%,(41.9±4.1)%].4 patients underwent diffusely IPA reveal severe restriction and obstruction,which diffusing capacity for carbon monoxide(DLCO) declined significantly(47.4±2.9% of predicted).Arterial oxygen tension(PaO2) was also lower(68.7±4.1 mmHg).Conclusions IPA is a common and severe complication in HSCT recipients.Decreased lung function(including restriction and obstruction) was obvious as a result of IPA.Diffusion impairment(such as diffusion capacity) was serious in patients with multi-site aspergillosis infection and/or recurrent infection.