18例肺曲霉病临床分析

Clinical analysis of 18 pulmonary aspergillosis cases

目的提高对肺曲霉病的认识。方法对诊断为肺曲霉病的18例病例的临床资料进行回顾性分析。结果83%的肺曲霉病患者伴有基础疾病;有临床症状者占89%;胸部影像表现为:以右肺为主,多见于上叶,且多分布于外周;大叶性肺炎型占17%,肺曲霉球型占50%,结节或肿块型占33%,支气管肺炎型占6%,双肺弥漫病变型占22%,且有22%合并胸腔积液;组织病理学发现呈约45°分支和有隔膜的曲霉菌丝;50%患者行肺叶切除术,术后应用抗真菌药物,50%患者仅接受抗真菌药物治疗;89%的患者治愈或好转,11%死亡。结论肺曲霉病患者多有基础疾病;部分类型有典型影像学改变;诊断需结合既往病史、临床表现和胸部影像表现及相关实验室检查,确诊有赖于组织病理学检查;治疗主要是药物,部分可手术。

Objective To get a better understand of pulmonary aspergillosis. Method A retrospective analysis of the clinical features of 18 pulmonary aspergillosis cases was performed.Result 83% of the patients had accompanying underlying diseases;The incidence of symptoms was 89%.Chest imaging findings：Lesions were mainly in the right lung,more common in the upper lobes,and mostly located in the peripheral;The cases of Lobar pneumonia-type accounted for 17% of all the patients,aspergilloma-type 50%,nodular or mass-type 33%,bronchopneumonia-type 6% and diffuse lesion-type 22%,with 22% of cases complicated with pleural effusion. Histopathological examination showed septate hyphae branching at an angle of approximately 45°.50% of patients underwent lobectomy and received antifungal medication after operation,while the other 50% received antifungal medication only; 89% of patients were fully recovered or improved,while 11% died.Conclusion Most of pulmonary aspergillosis patients have underlying diseases.Some types of pulmonary aspergillosis have typical imaging changes; Diagnosis requires a combination of past history,clinical manifestations,chest imaging findings and related laboratory examinations,and confirmed diagnosis is according to histopathological examination.To treat the diseases,most of patients need drug application,and some patients may undergo surgery.