侵袭性肺部真菌感染的临床分析

目的 研究侵袭性肺部真菌感染(IPFI)的临床特点.方法 回顾性分析2004年1月至2008年12月北京协和医院确诊为IPFI的48例患者的临床特点,并比较继发性和原发性IPFI的临床特点.结果 48例确诊病例主要是侵袭性肺曲霉菌感染和肺隐球菌病,各占37.5%,社区获得性感染占87.5%.66.7%的病例为继发性IPFI,以曲霉菌属感染为主,原发性IPFI以肺隐球菌为主.IPFI临床表现不特异,主要表现为咳嗽、发热、咯血、呼吸困难,影像学主要表现为双肺多发斑片影、结节影或弥漫病变(60.4%),出现肺内空洞占22.9%,继发性和原发性的临床表现和影像学异常比较差异无显著性.95.8%的病例接受抗真菌药物或者手术治疗,20.8%的病例死亡,均为继发性IPFI.继发性IPFI的病死率31.2%,与原发性IPFI比较差异具有显著性(P=0.033).结论 IPFI以曲霉菌感染和肺隐球菌病为主,大部分为社区获得性感染.继发性IPFI以曲霉菌属感染为主,临床表现和影像改变不特异,病死率高,需要尽早行侵入性手段协助诊断以早期治疗.

Clinical Analysis of Invasive Pulmonary Fungal Infections

Objective To investigate the clinical characteristics of invasive pulmonary fungal infec-tions (IPFI). Methods The clinical data of 48 patients with confirmed IPFI at Peking Union Medical College Hospital from January 2004 to December 2008 were retrospectively analyzed. Patients were divided into primary IPFI group and secondary IPFI groups based on their disease courses. Results The most commonly seen fungi were aspergillus species (37. 5% ) and cryptococcus species (37. 5% ) , and community acquired infections accounted for 87. 5%. The secondary IPFI accounted for 66. 7% among all cases, in which the major patho-gens were aspergillus species; in the primary IPFI group, the major pathogens were cryptococcus species. The symptoms of IPFI were non-specific and mostly presented as cough, fever, emptysis, and dyspnea. The com-mon imaging features included multiple nodules, infiltrates and consolidations, or diffused lesions in bilateral lungs, and cavities were found in 11 patients (22. 9% ). The clinical symptoms and imaging findings were not significantly different between these two groups. A total of 46 patients (95. 8% ) received antifungal therapies or surgeries. Ten patients (20. 8% ; all from the secondary IPFI group) died, making the fatality rate signifi-cantly different between the primary IPFI group and secondary IPFI group (P = 0.033 ). ConclusionsThe major pathogens of IPFI are aspergillus species and cryptococcus species, and most of them are community ac-quired. The secondary IPFI with aspergillus species tend to be highly fatal. The clinical symptoms and imaging features are non-specific. Early diagnosis with prompt antifungal therapies, or even with surgical intervention, may be beneficial for these patients.