慢性阻塞性肺疾病继发曲菌感染20例临床分析

Clinical Analysis of 20 Cases of Pulmonary Aspergiillosis Infection in Chronic Obstructive Pulmonary Disease

目的探讨慢性阻塞性肺疾病(COPD)继发肺部曲菌感染的临床特征、危险因素及诊断。方法回顾性分析20例COPD的临床资料并进行相关文献复习。结果 20例患者均是在治疗慢性阻塞性肺疾病过程中突然出现病情变化:15例出现胸闷加重,3例出现高热38～39℃,2例出现胸痛,1例出现咯血。影像学表现为:5例出现大片密度增高影,5例出现点片状网织阴影,3例出现多发小空洞影,3例片状影,3例出现多发结节影,1例出现空洞结节,伴空气新月征。20例患者治愈5例,死亡15例。结论 COPD继发曲菌感染,临床症状较重,死亡率高。广谱抗感染药物、糖皮质激素应用、侵袭性操作等是其发病的高危因素,及早诊断及时治疗可降低死亡率。

Objective To study the clinical characteristics,risk factors and diagnosis of aspergiilosis in COPD.Methods The clinical data of 20 patients in invasive pulmonary aspergiillosis with chronic obstructive pulmonary diseases was reviewed retrospectively.Results Conditions of patients with chronic obstructive pulmonary diseases were exacerbated in treatment： clinical manifestions include：exacerbation of dyspnoea in 15 cases,high fever 38℃～39℃ in 3 cases,chest pain in 2 cases,hemoptysis in 1 case.Imaging findings include：large area pulmonary consolidation in 5cases,sheet and streaky shadow in 5 cases, multiple small cavites in 3 cases,multiple nodules in 3 cases,pulmonary nodules in the cavites in 1 case with hole sign.5 cases were cured and the other 15 cases died.Conclusion The clinical manifestions were severe invasive pulmonary aspergiillosis with chronic obstructive pulmonary diseases,the mortality was high,long term uses of broad spectrum antibiotics and glucocorticoid hormone or invasive operation may be frequent risk factors.Early diagnosis and treatment may decrease the mortality of the disease.