肺曲霉病12例临床分析

Clinical Analysis for 12 cases of pulmonary aspergillosis

目的探讨侵袭性肺曲霉病的临床表现和影像学特点。方法回顾性调查研究汕头大学医学院第一附属医院自1998年1月至2007年12月确诊的12例侵袭性肺曲霉病。结果肺曲霉病的症状主要表现为咳嗽10例（83.3%）,咳白黏痰5例（41.7%）,咯脓痰4例（33.3%）,咯血痰3例（25.0%）,咯血2例（16.7%）,咯血量10～50ml/次,发热6例（50.0%）,胸闷3例（25.0%）,胸痛3例（25.0%）,消瘦4例（33.3%）,盗汗3例（25.0%）,喘息1例（8.3%）。影像学主要表现为：3例（25.0%）发现空洞内球状软组织影,球形内容物与洞壁存有新月形或环形透亮影,4例（33.3%）浸润性团块阴影;2例（16.7%）表现为肺内孤立圆形结节状影;2例（16.7%）表现为肿块样软组织密度影;1例（8.3%）表现为两肺弥漫性斑片状实变影。确诊方法：12例均临床确诊。其中外科手术后病理报告8例（66.7%）,纤维支气管镜下活检2例（16.7%）,纤维支气管镜无菌毛刷刷检找到曲霉菌菌丝及孢子1例（8.3%）,经纤维支气管镜抽吸病灶部位分泌物或以灌洗液做霉菌培养获阳性结果1例（8.3%）。12例肺曲霉病,其中7例误诊,误诊率达58.3%,多误诊为肺结核、肺癌。结论肺曲霉病的症状及影像学改变不典型,误诊率高,病理组织活检具有重要的诊断价值。

Objective To investigate the clinical manifestation and image features of pulmonary aspergillosis. Methods Clinical data of 12 cases patients with pulmonary aspergillosis from the first affiliated hospital of medical college of Shantou university from January 1998 to December 2007 were analyzed retrospectively. Results The main symptom of pulmonary aspergillosis were cough（ 10 cases,83. 3% ）,phlegm（5 cases,41.7% ）,pyoptysis（4 cases ,33. 3% ）, sputum cruentum（ 3cases ,25.0% ）, emptysis （2 cases, 16. 7% ） ,fever （6 cases ,50. 0% ）, chest distress （3 cases,25. 0% ） ,emaciation（4 cases,33.3% ） ,night sweat （3 cases,25. 0% ） ,gasp（ 1 case,8. 3% ） ;The imaging features were as following：globular-llke soft tissue shadow accompanied with crescent-shaped shadow （3 cases,25. 0% ）, invasive clumping shadow （4cases,33. 3% ）, spherical noeud shadow （2 cases, 16. 7% ）,soft tissue lump（2 cases, 16. 7% ） ,lamellar effusion lesions（ 1 cases,8. 3% ）. Final diagnosis means were as follow：diagnosed by surgery （8 cases,66. 7% ） ,by biopsy via bronchofibroscope（2 cases,16. 7% ） ,hair-brush to find aspergillus mycelial and sporus （ 1 case,8. 3% ） ,by mycetes culture method（ 1 case,8. 3% ）. Misdiagnosis rate was 58. 3%. It was common to be misdiagnosed as lung tuberculosis or bronchiogenic cancer. Conclusion The symptoms and imaging features for pulmonary aspergillosis were not typical and with a high misdiagnosis rate. Tissue biopsy carried vital significance for diagnosis of pulmonary aspergillosis.