慢性阻塞性肺病继发曲霉菌感染96例临床分析

Clinical analysis on ninty-six cases of secondary aspergillosis in COPD patients

目的探讨慢性阻塞性肺病(COPD)继发呼吸系统曲霉菌感染的临床特点及防治对策。方法分析浙江大学附属第一医院2007年6月至2008年6月收治的96例COPD痰培养曲霉菌阳性患者的临床表现、治疗方法及治疗结果。结果96例COPD痰培养曲霉菌阳性患者经治疗后,9例死亡,87例好转,其中45例未用抗真菌药物治疗,38例应用氟康唑针治疗,13例加用伏立康唑针治疗。结论近年来COPD患者痰培养曲霉菌阳性呈持续增多趋势,感染因素为长期反复住院、老年、抗生素及激素的不合理应用、医源性侵袭性操作,早期诊断,早期治疗及合理预防用药是减少呼吸系统曲霉菌感染发生的关键。

Objective To discuss the clinical features and control measure of respiratory infection associated with aspergillosis secondary to chronic obstructive pulmonary disease.Method 96 cases of COPD patients with aspergillus in their sputum culture,admitted into the First Affiliated Hospital of Zhejiang University from June 2007 to June 2008,were collected and their clinical manifestations,treatment and treatment outcome were analyzed.Result Among the 96 cases of COPD patients with aspergillosis,9 cases patients died after treatment, 87 cases improved including 45 cases treated with non-antifungal agents,38 cases with fluconazdc and 13 cases with the addition of Voriconasole. Conclusion COPD patients with aspergillosis were increasing in recent years. The risk factors of aspergillus infection includes repeatedly longterm hospitalization,advance in age,irrational antibiotics and hormones appllcatlon,as well as latrogenie and invasive operation. Early diagnosis, early treatment and rational precautionary can be a key to reduce the occurrence of respiratory infection by aspergillus.