无基础疾病的肺曲霉病52例临床分析

目的 分析无基础疾病的肺曲霉病患者的临床特征,提高对该病的认识及诊治.方法 选取2009年1月—2019年1月郑州大学第一附属医院无基础疾病的肺曲霉病患者为研究对象,对相关资料进行回顾性分析.所有患者均获得病理学诊断依据.结果 52例患者中,侵袭性肺曲霉病临床症状出现时间多在10～15 d,慢性坏死性肺曲霉病和肺曲霉球...

Clinical analysis of 52 cases of pulmonary aspergillosis in patients without underlying disease

Objective To analyze the clinical features of pulmonary aspergillosis in patients without underlying diseases for improving the diagnosis and treatment of this disease.Methods From January 2009 to January 2019,patients with pulmonary aspergillosis treated in the First Affiliated Hospital of Zhengzhou University were selected as study subjects.The relevant data were analyzed retrospectively.Pathologic diagnosis was obtained for all patients.Results The onset time was 10-15 days for the clinical symptoms of invasive pulmonary aspergillosis,and mostly 1-2 months for the clinical symptoms of chronic necrotizing pulmonary aspergillosis and aspergillus fungus ball.Fever,cough,sputum,hemoptysis,and chest pain were the most common symptoms of invasive pulmonary aspergillosis(53.8%,14/26).Cough,sputum,and bloody sputum were reported in most(76.2%,16/21)of the patients with chronic necrotizing pulmonary aspergillosis.Three patients had fever and/or chest pain,and 2 patients did not have any symptoms.Hemoptysis was usually the only symptom of pulmonary aspergillus ball(4/5).The remaining one patient had cough.Increased C-reactive protein,procalcitonin,and erythrocyte sedimentation rate were found in 32.7%(17/52),28.8%(15/52),and 34.6%(18/52)of the patients,respectively.Only a few patients(15.0%)had positive G test and GM test.Imaging studies indicated that invasive pulmonary aspergillosis lesions were mostly located in both lungs(57.7%,15/26),associated with inflammation and peripheral inflammatory exudation(69.2%,18/26).Chronic necrotizing pulmonary aspergillosis and pulmonary aspergillus ball were mostly located in unilateral lung,associated with nodules and cavities(85.7%and 5/5).Timely antifungal therapy or surgery resulted in good outcome evidenced by clinical and radiological improvement in 51 patients(98.1%).Conclusions The clinical manifestations of pulmonary aspergillosis are atypical in patients without underlying diseases,especially chronic necrotizing pulmonary aspergillosis and pulmonary aspergillus ball,which are easily confused with tumors.When the diagnosis is unclear,the appropriate diagnostic approach should be used timely for early treatment and improving outcome.