肺曲霉病30例临床分析

Clinical analysis of 30 patients with pulmonary aspergillosis

目的总结肺曲霉病的临床表现、影像学特点及诊断和治疗方法,以提高对该病的认识。方法回顾性分析该院2002年1月-2008年6月经病理确诊为肺曲霉病的住院患者30例,总结其临床表现、影像学特点、诊断及治疗情况。结果 30例患者中,既往有基础疾病者27例(90.0%)。其中,肺结核11例(36.7%),支气管扩张5例(16.7%)。肺曲霉病的主要症状为咳嗽24例(80.0%),咳痰19例(63.3%),咯血18例(60.0%)。影像学表现多样,肿块结节型21例(70.0%),渗出型5例(16.7%),患肺毁损1例,患肺术后改变3例。其中,10例同时形成空洞(33.3%)",洞中球征"和"晕征"各6例(20.0%)。所有病例均经过病理检出。手术切除后病理检出20例,占66.7%;纤维支气管镜下活检检出7例,占23.3%;CT引导下经皮肺穿刺活检检出1例;胸水培养检出1例;支气管镜下取肺组织培养检出1例。该组病例在病理诊断前误诊率高达66.7%,误诊为肺结核10例(33.3%),肺癌6例(20.0%),细菌感染3例,支气管扩张并感染1例。20例(66.7%)经外科手术切除,随访均无复发;7例(23.3%)经药物治疗,6例痊愈或显效。结论肺曲霉病多继发于肺部基础疾病,临床表现以咳嗽、咳痰、反复间断咯血为主,确诊有赖于病理学;该病误诊率高,外科治疗和抗真菌药物治疗有较好的疗效。

【Objective】To investigate the clinical manifestations, imaging features ,diagnosis and managements of pulmonary aspergillosis （PA）.【Methods】30 patients with PA, identified by pathological examinations, in our hospital from January 2002 to June 2008 were studied retrospectively. Clinical manifestations, imaging features, diagnostic methods and managements were analyzed. 【Results】27 of 30 cases （90.0%） had underlying diseases, 11 cases （36.7%） of tuberculosis, 5 cases（16.7%） of bronchiectasia. Main symptoms include： cough 24 cases （80.0%）, expec- toration 19 cases（63.3%）, haemoptysis 18 cases（60.0%）. The X-ray and chest CT showed masses or nodules lesions （21 cases 70.0%）, patchy lesions （5 cases 16.7%）, cavitary lesions （10 cases, 33.3%）, ＂halo sign＂（6 cases 20%） and＂crescentic sign＂ （6 cases 20%）. All the patients were identified by pathological examinations. 20 cases （66.7%） obtained lung or bronchi tissues by operation, 7 cases （23.3%） by bronchofibroscope, 1 case by CT-guided percutaneous needle biopsy. 1 case was confirmed by culture of pleural effusion, 1 case was confirmed by culture of tissue culture obtained by bronchofibroscope. Among 30 cases, 20 cases （66.7%）were misdiagnosised before pathological examinations, 10 cases （33.3%） were misdiagnosised as tuberculosis, 6 cases （20.0%） were misdiagnosised as lung cancer, 3 cases were misdiagnosised as pneumonia, 1 case was misdiagnosised as bronchiectasia. 20 cases （66.7%） underwent surgical resection of pulmonary lesions. No one recured after operation. 7 cases（23.3%） received systemic anti-fugal therapy, 6 cases were recovery or excellence.【Conclusions】Most of PA had underlying diseases. Cough, expectoration, repeated, interrupted haemoptysis were main manifestations. Final diagnosis was mainly depended on pathological examinations. PA was usually misdiagnosed. Satisfactory results can be obtained by both anti-fungi treatments and surgical treatment.