52例侵袭性肺曲霉菌病临床分析

目的分析侵袭性肺曲霉菌病(IPA)的临床特征。方法对52例IPA患者的基础疾病、宿主因素、临床特征、治疗及转归进行回顾性分析。结果原发性IPA共8例,均获治愈;44例继发性IPA患者,治愈35例,死亡9例。恶性肿瘤放化疗、器官移植、慢性阻塞性肺病急性加重者中,继发性IPA的发病率较高,其临床表现主要有发热、咳嗽、咳痰、喘息、呼吸困难、咯血。IPA患者的肺CT改变呈多样性,并呈动态演变。结论原发性IPA一般预后良好,继发性IPA好发于免疫缺陷的患者,临床表现缺乏特异性,肺CT具备一定的特征,结合宿主因素,为早期治疗提供诊断依据,从而改善预后。

Clinical analysis of 52 cases of invasive pulmonary aspergillosis

Objective To explore the clinical characteristic,diagnosis and management of invasive pulmonary aspergillosis.Methods The clinical data of 52 patients with IPA from January 2006 to July 2011 in our respiratory medicine department and RICU were retrospectively analyzed.Results Of the 52 patients,primary IPA was diagnosed in 8 cases,and secondary IPA was diagnosed in 44 cases.The 52 patients included 13 "proven" and 39 "probable" cases.Radiotherapy and chemotherapy of malignant tumor,organ transplantation and chronic obstructive pulmonary disease were the much more common basis of secondary IPA.Among those 44 patients,20 cases received broad spectrum antibiotic treatment,16 cases used glucocorticoid treatment,12 cases received immunosuppressant,application of artificial airway and deep venous catheter were respectively in 11 and 9 cases.Clinical manifestations included fever,cough,expectoration,breathless,dyspnea and hemoptysis.CT features were identified: multi-patchy patterns,nodules or masses,halo sign,consolidation,cavitary lesions,tree-in-bud patterns,air-cresent sign,thickening of bronchovascular bundle,diffuse ground-glass opacity,pleural effusion.Most patients presented with a combination of 2 or more of those signs.In those IPA patients,voriconazole was the drug of choice.Conclusions Primary IPA was prone to occur among people with normal immune system,while secondary IPA was vulnerable to immunodeficiency or immunocompromised patients.The patients with IPA lacked of specific clinical manifestations.Diagnosis of IPA might be difficult,but pulmonary CT had some certain features,combined with risk factors,non-invasive diagnostic tool,such as the galactomannan antigen test(GM),sputum and BALF culture,and the clinical diagnosis of IPA might be obtained.The mortality of secondary IPA was higher than primary IPA.Early diagnosis and reasonable treatments could remarkably improve the prognosis of IPA.