慢性阻塞性肺疾病合并侵袭性肺曲霉病病例报告并文献回顾

目的:结合文献总结慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(IPA)患者的临床特征,提高早期诊治水平。方法:对1例经支气管镜肺活检确诊的重度COPD合并IPA患者的临床资料进行分析,并回顾复习有关文献。结果:COPD合并IPA患者严重呼吸困难多见。本例患者胸部CT可见中央型支气管扩张、小结节影、不典型渗出影,血清半乳甘露聚糖抗原检测(GM试验)及1.3-β-D葡聚糖检测(G试验)阳性。经支气管镜肺活检病理学检查见曲菌丝及炎症细胞浸润。结论:COPD合并IPA诊断困难,病死率高,综合分析临床表现、影像学、微生物学及血清学检查结果是提高诊断率、改善预后的有效手段。若临床情况允许,应尽早进行支气管镜等有创检查确定诊断。

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case report with literature review

Objective:Invasive pulmonary aspergillosis(IPA) occurred mainly in immunocompromised hosts,however increasing numbers of IPA had been reported among basically immunocompent patients who had some pulmonary abnormalities such as chronic obstructive pulmonary disease(COPD).To investigate the clinical manifestations of IPA in patients with COPD,and improve its level of early diagnosis and treatment,the data of a proven IPA patient associated with severe COPD were analyzed.Methods: The clinical data of a 59-year-old male patient conformed by transbronchial lung biopsy in Beijing Anzhen Hospital in 2010 were retrospectively analyzed for clinical features,diagnosis and prognosis,and related literatures were reviewed.Results:The use of Corticosteroid was an important risk factor in IPA,which was usually used for the treatment of underlying COPD.The clinical presentation of IPA in patients with COPD was nonspecific,severe dyspnea was more common,and others included refractory pneumonia/antibiotic-resistant lower respiratory tract infection,etc.The chest radiograph of this patient was normal early in the course of the entity,and then presented central bronchiectasis,small nodules and nonspecific infiltration shadowing.Biological investigation such as the galactomannan antigen test(GM-test) and 1,3-beta-glucan test(G-test) were positive,which may be helpful in its diagnosis.There was no identical view on GM-test of bronchoalveolar lavage fluid in the diagnosis of invasive pulmonary aspergillosis among non-immunocompromised hosts.Confirmed aspergillus species by tissue biopsy and microscopic examination was the gold standard.Conclusion: In COPD patients,IPA diagnosis remains difficult and the global mortality rate reported in the literature is still high.Prognosis could be improved by more rapid diagnosis.Diagnosis is usually based on the combination of clinical features,radiological findings,microbiological examination and serological tests.In the case of patient safety,electronic bronchoscopy is required to carry out bush,biopsy and bronchoalveolar lavage as soon as possible.If the patient’s status is severe,therapy should be promptly given to supply the patients with chance of relief,and then diagnostic procedures are made to confirm the clinical suspicion of IPA.Comprehensive management,especially in nutritional support,is very important to restore a patient’s own immunity status.