2015慢性肺曲霉菌病诊断和治疗临床指南解读

慢性肺曲霉菌病(CPA)是一种罕见的肺部疾病,指慢性肺部曲霉菌感染,病程超过3个月。CPA常继发于其他呼吸系统疾病,如肺结核、变应性支气管肺曲霉菌病、结节病等,如不积极治疗,5年病死率较高 (75%~80%),因此需提高临床医师对CPA的全面认识,以期尽早明确诊断,并给予恰当治疗,以降低其病死率。近年来,随着CPA患病人数的逐渐增多,临床医师对该病的认识不断提高,关于CPA诊治的研究成果日益增多。近期,欧洲临床微生物学和感染性疾病联合会(ESCMID)、欧洲呼吸学会(ERS)合作,总结了关于CPA的前期研究成果,发布了CPA临床诊治指南,对CPA的定义、临床分型、实验室检查、影像学检查、诊断标准、治疗和随访等进行了系统性阐述,本文对其进行解读,旨在学习并分享关于CPA领域的最新成果,以指导临床治疗。

Chronic pulmonary aspergillosis:rationale and clinical guidelines for diagnosis and management

Chronic pulmonary aspergillosis (CPA) is an uncommon lung infection disease caused by the fungus Aspergillus. The duration of CPA is usually more than 3 months. CPA is often secondary to other respiratory diseases, such as tuberculosis, allergic bronchopulmonary aspergillosis (ABPA) and sarcoidosis, et al. If not active treatment, 5 years of mortality will be high (75%-80%). Therefore, it is necessary for clinicians to comprehensively improve the understanding of CPA, in order to confirm the diagnosis and give appropriate treatment as soon as possible, eventually to decrease the mortality rate. In recent years, with the gradual increase in the number of CPA patients, the clinicians' understanding of the disease is more and more improved, the research results of CPA diagnosis and treatment are increasing day by day. Recently, an expert group from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and from the European Respiratory Society (ERS) summarized the results of preliminary research on CPA, and released a rationale and clinical guideline for diagnosis and management of CPA. This guideline covers the definition, clinical classification, laboratory examination, imaging examination, diagnostic criteria, treatment, follow-up of CPA and etc. This article is an interpretion of the newest guideline, aims to learn and share the latest achievements in the field of CPA, ultimately to direct clinical management.