非粒细胞缺乏患者肺曲霉菌病 16 例临床研究简

目的 探讨非粒细胞缺乏肺曲霉菌病患者的临床表现、影像学特点及诊断治疗方法.方法回顾性分析16例确诊的肺曲霉菌病患者的临床资料.结果 曲霉菌球菌病3例,变态反应性支气管肺曲霉菌病1例,侵袭性肺曲霉菌病12例.主要症状为咳嗽、咯痰、发热、咯血、胸闷和气喘,肺部体征不明显.胸部CT表现：双肺多发病灶13例,单病灶3例.所有患者均接受抗真菌药物治疗,死亡6例皆为侵袭性肺曲霉菌病患者.结论 曲霉菌球菌病病情发展缓慢,部分病人需要手术切除病灶;变态反应性支气管肺曲霉菌病情时轻时重,早期常误诊为支气管哮喘;侵袭性肺曲霉菌病情进展迅速,死亡率高,降低病死率有赖于早期诊断及抢先治疗.

Clinical analysis of 16 cases of pulmonary aspergillosis in non-agranulocytosis patients

Objective To analyze the clinical and chest image characteristics and treatment of pulmonary as- pergillosis in non-agranulocytosis patients. Methods The clinical data of 16 patients diagnosed as proven pulmonary aspergillosis were retrospectively analyzed. Results There were 3 cases of parasitic pulmonary aspergillosis （ 18. 8% ）, 1 case of allergic pulmonary aspergillosis （6.3%）, and 12 cases of invasive pulmonary aspergillosis （75%）. The main symptoms included cough, sputum, fever, haemoptysis, chest tightness and shortness of breath. Lung signs were not obvious in all cases. Chest CT manifestations included 13 cases of double lung multiple lesions and 3 cases of single lesions. All of the patients accepted antifungal therapy, and 6 cases of death reported. Conclusion The development of parasitic pulmonary aspergillosis is slow, and some patients need surgical resection lesions. Allergic bronchial pulmonary aspergillus need long period of treatment, which is often misdiagnosed as asthma.