曲霉菌性坏死性支气管炎5例临床分析及文献复习

clinical analysis of 5 patients with aspergillus necrotizing bronchitis

目的 对曲霉菌性坏死性支气管炎的临床特征和诊治作初步分析.方法 回顾性分析5例曲霉菌性坏死性支气管炎病例的临床表现、影像学与内镜检查资料、诊治方法及预后,并复习国内外相关文献.结果 5例患者临床症状有咳嗽、咳痰、气急、发热及咯血等.确诊前症状持续中位时间为4个月.其中3例有易感因素,气管镜下表现为表面坏死物、黏膜充血肿胀、气管狭窄,以及新生物样改变伴支气管阻塞等;ct表现为气管壁狭窄增厚、阻塞性肺炎和肺部块影等.结论 曲霉菌性坏死性支气管炎的临床表现无特异性.胸部ct和气管镜在其诊断中起重要作用,确诊需有组织学依据,部分患者合并支气管内膜结核.一旦确诊,均需抗真菌治疗.对于单纯药物治疗无效或不能耐受者,根据部位可考虑手术切除,气道狭窄者可行气管镜介入治疗. abstract： objective to elucidate the clinical features, diagnosis and treatment of aspergillus necrotizing bronchitis. methods medical records and investigation data from 5 eases of aspergillus necrotizing bronchitis were retrospectively analyzed, and related literatures were reviewed. results five patients (3 males and 2 females) with mean age of 63.6 y were enrolled in this study. all patients had histopathologically proved necrotizing aspergillosis of the large airways. common presentations included cough, short of breath, sputum production, fever and haemoptysis. tracheoscopy presentations included necrosis, mucous hyperemia, focal airway constriction and neoplasm. the ct findings included bronchial wall thickening, narrowing of the bronchial lumen, which was often associated with distal obstructive pneumonia. conclusions the clinical manifestations of aspergillus necrotizing bronchitis are nonspecific, and histopatholagical diagnosis is essential for a definite diagnosis and can be supported by tracheoscope or imaging techniques.