侵袭性曲霉菌病13例临床特点分析

Retrospective analysis on the clinical features of 13 cases of invasive pulmonary aspergillosis

目的分析侵袭性肺曲霉病（IPA）的临床特点,提高对本病的认识。方法对13例确诊的IPA患者的临床资料进行回顾性分析。结果 IPA患者中存在基础疾病或危险因素者占69.2%（9/13）;临床表现包括咳嗽、黄痰（13/13）、高热（11/13）、胸闷或呼吸困难（7/13）和咯血（2/13）等;92.3%（12/13）患者有高白细胞血症,WBC大多为（1530）×10^9;10例G试验检测的患者中有9例出现阳性;影像学检查：肺内多发空洞及＂空气新月征＂9例（69.2%）,＂晕轮征＂2例（15.4%）,支气管炎表现6例（46.2%）,胸腔积液3例（23.1%）,颅内播散病灶1例;气管镜检查以粘膜水肿、脓痰、管腔坏死物为主;9例患者痰培养或肺泡灌洗液培养阳性（占69.2%）,所有患者病理检查均见曲霉菌丝。所有患者均接受抗真菌药物治疗,4例好转出院,9例恶化放弃治疗或死亡。结论 IPA是临床严峻挑战;掌握该病的临床特点、实验室检查和胸部影像特征,及时的气管镜、组织病理检查有助于IPA确诊。临床医师应高度重视曲霉病。

Objective To analyze the clinical features of invasive pulmonary aspergillosis（IPA）,in order to enhance the awareness of the disease.Method Clinical data of 13 patients with IPA,who were diagnosed by etiology or pathology,were retrospectively analyzed.Result 69.2%（9/13） of the patients had underlying diseases or risk factors,the clinical manifestations including cough and sputum production（100%,13/13）,pyrexia（84.62%,11/13）,chest tightness or shortness of breath（53.8%,7/13）,hemoptysis（15.4,2/13）;Clinical examination showed that 92.3%（12/13） of the patients had leukocytosis with WBC counts about（1530）×10^9,all with elevated neutrophils;1,3-β-D glucan test（G test） were positive in 9 cases of the 10 patients tested（up to 90%）;imaging findings were： single or multiple pulmonary cavities in 9 cases（69.2%） including ＂air crescent sign＂,＂halo sign＂ in 2 cases（15.4%）,bronchitis in 6 cases（46.2%） and pleural effusion in 3 cases（23.1%）;mucosal edema,necrosis and purulent sputum were the main trachea microscopic manifestations;the etiology of 9 cases（69.2%） were determined by sputum or bronchoalveolar lavage fluid culture;all IPA patients were pathologically confirmed by detecting Aspergillus hyphae in tissues.All cases received antifungal therapy.Finally,4 patients improved and discharged;9 cases died or abandoned medical treatment because of deterioration.Conclusion Invasive pulmonary aspergillosis is a serious clinical challenge;fully understanding the features of clinical manifestations,laboratory examinations and chest radiography,timely bronchoscopy and pathological examinations will facilitate IPA confirmation.Clinicians should attach great importance to aspergillosis.