慢性坏死性肺曲霉病18例临床分析

Chronic necrotizing pulmonary aspergillosis:analysis of 18 cases

目的 探讨慢性坏死性肺曲霉病（CNPA）的临床特征、诊断与治疗，以提高对该病的认识。方法 对2003年1月-2006年3月广州呼吸疾病研究所经病理证实的18例慢性坏死性肺曲霉病住院病例进行回顾性研究，结合文献分析其临床表现、影像学、诊断和治疗方法。结果CNPA症状无特异性，主要表现为咳嗽、咳痰18例（100.0％），咯血9例（50.0％），咳血痰1例（5．6％），发热7例（38．9％），气促5例（27．8％），盗汗3例（16．7％），胸痛3例（16.7％），消瘦3例（16．7％），疲乏无力2例（11.1％）。右肺病变5例（27．8％），左肺病变11例（61．1％），双肺受累2例（11.1％）。病灶位于下肺6例（33．3％），上中肺9例（50.0％），双肺弥漫病变1例（5．6％），双肺多发空洞1例（5．6％），左侧毁损肺1例（5．6％），不常见的胸膜（腔）受累共4例。“空气新月征”有提示诊断意义，在本组中发现8例（44.4％）。全部病例均经病理确诊，其中经支气管肺组织活检确诊7例。结论CNPA临床表现无特异性，影像学检查在诊断中起重要作用，而诊断需要病理依据。存在肺部基础疾病，出现发热、血痰及空气新月征三联征时，应高度警惕CNPA。系统抗真菌治疗无效、合并大咯血或肺部阴影与肿瘤不能鉴别时，可考虑手术切除。

Objective To review clinical manifestation,diagnosis and treatment in patients with chronic necrotizing pulmonary aspergillosis （CNPA）. Methods A retrospective analysis of 18 patients with CNPA confirmed histopathologically studies. All patients were admitted to the Guangzhou Institute of Respiratory Disease during 2003 - 2006. Results The clinical manifestation of CNPA were non-specific. Common presentation included cough （ 18 cases, 100. 0% ）, haemoptysis （ lOcases, 55.6% ）, fever （7cases, 38.9% ）, dyspnea （Scases,27.8%）, night-sweat （3cases, 6. 7% ）, chest pain （3cases, 16.7% ）, emaciation （3cases, 16.7% ） and adynamia （2cases,11.1% ）. Pulmonary lesions occurred in right side were presented in 5 cases,left side in 11 ,and bilateral sides in 2. Bilateral polycavitates were presented in 1 case,tuberculous destroyed lung in 1 case. Radiographically, the air crescent sign was suggestive of the diagnosis ,which was found in 8 patients （44.4%）. The diagnosis was confirmed in all cases by pathological findings. Conclusions The clinical manifestation of CNPA are non-specific. Radiography plays a pivotal role in the diagnosis of CNPA. Treatment with antifungal medications is indicated once the diagnosis was made. Pulmonary resection should be considered when patients have prolonged illness or frequent haemoptysis.