医院感染性肺曲霉病临床分析

Clinical analysis of hospital acquired pulmonary aspergillosis

目的分析医院感染性肺曲菌病的临床特点及危险因素,以便有效的控制感染。方法对2003年8月～2006年10月间经病原学证实的医院感染性肺曲菌病患者的临床资料进行回顾性分析。结果该组病例均患有1种以上基础疾病,主要为慢性阻塞性肺病8例、支气管哮喘2例、糖尿病7例、肺间质纤维化5例、原发性肺部肿瘤4例、其他部位肿瘤6例。先期曾使用广谱抗生素者25例,使用糖皮质激素者20例。血浆清蛋白降低者21例,白细胞升高者18例及白细胞减少者3例。临床主要表现为咳嗽、咳痰25例,痰多为棕黄色脓痰19例,少为白色粘痰6例,14例病人伴咯血。喘息19例,发热11例。X线胸片或CT表现为斑片状阴影9例,以胸膜为基底的多发楔形阴影合并胸腔积液6例,多发小结节4例,空气新月症5例。17例死亡。结论医院感染性肺曲菌病易发生患有多种基础疾病、血浆清蛋白降低、先期曾使用广谱抗生素和使用糖皮质激素治疗的患者。患者多病情严重,治疗困难,且病死率高。合理使用抗生素和激素,改善营养状况是防止医院感染性肺曲菌病发生的重要措施。早期诊断及应用有效的抗真菌药是治愈医院感染性肺曲菌病的关键。

[Objective] To investigate the risk factors and clinical characteristics of hospital acquired pulmonary aspergillosis. [Methods] The clinical data of 25 patients with hospital acquired pulmonary aspergillosis who admitted to the first affrliated hospital Harbin medical university from August 2003 to October 2006 were reviewed retrospectively. [Results] All patients had following conditions, chronic obstructive pulmonary disease （n =8）, bronchial asthma （n =2）, diabetesmellitus （n =7）, idiopathic pulmonary fibrosis （n =5）, primary lung cancer （n =4）, other cancer （n =6）. Predisposing factors or risk factors for hospital acquired pulmonary aspergillosis included use of high dose broad-spectrum antibiotics （n =25） corticosteroids （n =20）, hypoproteinemia （n =21） leukocytosis （n =18） and neutropenia （n =3）. The clinical manifestations included productive cough with purulent sputum （n =23）, breathlessness （n =19）, hemoptysis （n =14）, fever（ll）. The chest X-ray in some cases revealed infiltration in lower lobes of both lungs. Pleural fluid was found in some of the cases. [Conclusion] The hospital acquired pulmonary aspergillosis in patients are closely associated with the use of high dose broad-spectrum antibiotics, and high dose corticosteroids. Judicious use broad-spectrum antibiotics and corticosteroids, improving nutritional status may decrease the infection of pulmonary aspergillosis. Early diagnosis and therapy with effective antifungal drugs are key for successful management of hospital acquired pulmonary aspergillosis.