侵袭性肺曲霉菌病8例临床分析

Pulmonary invasive aspergillosis:clinical analysis of 8 cases

目的总结侵袭性肺曲霉菌病(IPA)的临床特点,以利早期诊断。方法回顾性分析2006年4月至2006年12月解放军总医院呼吸科确诊的8例IPA患者的临床资料。结果本组病例全部经病理诊断为IPA。6/8的患者出现发热症状;1/2的患者具有"新月征"、"气环征"的CT表现;7/8的患者有病灶内空洞或空腔形成;1/2患者痰培养曲霉菌阳性,1/4的患者在病理诊断前痰培养阳性;本组入院前初次诊断正确率为0;本组1例系统性曲霉菌病患者死亡,7例经治疗好转出院。结论IPA的临床症状缺乏特异性,早期具有典型CT表现者较少,痰培养曲霉菌阳性率低,这些原因容易造成早期误诊。因此应关注有基础疾病的患者,对于新发肺部阴影者警惕IPA的可能,对可以耐受经皮肺穿刺或气管镜者,通过尽早病理检查等措施可提高早期诊断率。

Objective To summarize the clinical characteristics of invasive pulmonary aspergillosis（IPA） in order to facilitate diagnosis. Methods The clinical features of 8 cases of IPA from Apr. to Dec. 2006 in our department were analyzed retrospectively. Results Six cases had fever. Crescent sign or ring sign were shown on CT in 4 cases. Seven patients had cavity formation in the focus. In 4 patients, there was positive Aspergillus cultures of sputum, and 2 cases had posifive sputum culture before pathological diagnosis. The correct primary diagnostic rate of IPA was zero before admission. One case died and other 7 cases were improved and discharged. Conclusion The causes of misdiagnosis of IPA are lack of specificity of symptoms and early CT, and low positive rate of culture of sputum. So attention should be paid to the patients with underlying diseases and the possibility of IPA in patients with new shadow in lung. For the patients who can tolerate percutaneous lung puncture or tracheoscopy, pathological examination should be performed in order to improve early diagnosis.