肺曲霉病23例临床分析

Clinical analysis of 23 cases of pulmonary aspergillosis

目的探讨肺曲霉病的临床特点,提高对本病的认识。方法对23例经病理确诊的肺曲霉病患者的临床资料进行回顾性分析。结果91%的肺曲霉病伴有基础疾病。咳嗽、咯痰发生率为60%,咯血为44%,胸憋、气短、呼吸困难为39%,发热为30%,无症状者为13%。胸部影像表现为:空腔内有肿块、周围有空气新月征30%,单侧或双侧多发空洞伴肺浸润阴影26%,支气管肺炎型9%,肺梗塞型4%,肺结节或肿块17%,其他表现13%。支气管镜检查13%有异常改变。组织病理检查发现有45°分支和隔膜的曲霉菌丝。35%的患者行肺叶切除术,66%患者给予抗真菌药物治疗,大多数患者经治疗好转或痊愈。结论肺曲霉病多有基础疾病,诊断主要根据既往病史、临床表现和胸部影像学表现,确诊依赖于肺组织内发现曲霉菌丝,治疗主要包括药物和手术治疗。

Objective To investigate the clinical feature of pulmonary aspergillosis for a better understanding of this condition. Methods The clinical features of pulmonary aspergillosis in 23 histopathologically confirmed cases were retrospectively analyzed. Results In these cases, 91% of pulmonary aspergillousis arose from underlying comorbidities. The incidence of symptoms was 60% for productive cough, 44% for haemoptysis, 39% for breathlessness or dyspnea, 30% for fever, and 13% for asymptomatic presentation, respectively. By chest radiography, cavity-enclosed mass with air crescent sign was found in 30% of time, unilateral/bilateral pulmonary infiltrates with multiple cavitation in 26%, bronchopneumonia in 9%, pulmonary embolism in 4%, pulmonary nodules or masses in 17%, and other else in 13%. Fiberoptic bronchoscopy revealed that 13% of the patients were abnormal. Histopathological examination showed septate hyphae branching at an angle of approximately 45°. 35% of patients undensent lobectomy, while the remaining 66% received antifungal medication. The vast majority of patients improved or fully recovered. Conclusion A majority of pulmonary aspergillosis developed from underlying diseases. Diagnosis is principally based on a past history, clinical manifestations and chest radiography. Presence of septate branching hyphae in the lung tissue may lead to a diagnostic confirmation. Management of this condition includes antifungal agents and surgery.