非粒细胞缺乏患者侵袭性肺曲霉菌病9例临床分析

Clinical analysis of 9 cases of invasive pulmonary aspergillosis

目的探讨非粒细胞缺乏患者侵袭性肺曲霉菌病(IPA)的临床表现、诊断和治疗特点。方法回顾性分析我院2009年3月至2010年8月收治的9例IPA的基础疾病、危险因素、临床表现、实验室及影像学特征、治疗和预后情况。结果 9例IPA患者确诊2例,临床诊断7例。2例患者无特殊病史,其余7例均有基础疾病。主要症状为发热、咳嗽、咯痰、咯血、胸闷和气喘。痰培养6例查见曲霉菌。G试验及GM试验阳性5例。2例支气管镜检查病理形态学及特殊染色结果符合曲霉菌感染。影像学表现呈多样性。9例患者均接受抗真菌药物治疗,其中8例随诊,失访1例。5例选用伏立康唑初始治疗;3例初始治疗分别为伊曲康唑、米卡芬净及卡泊芬净,治疗效果欠佳,换用伏立康唑仍有良好疗效。结论非粒细胞缺乏IPA患者临床表现缺乏特异性,早期诊断和尽早应用抗曲霉菌药可降低病死率。

Objective To study the clinical features,the diagnosis and treatment of invasive pulmonary as- pergillosis（IPA）in patients without agranulocytosis. Methods We retrospectively enrolled patients with IPA be- tween March 2009 and August 2010 in a convenience manner. Diagnosis is usually based on a combination of clin- ical features, radiological findings, microbiological results and, sometimes, serological information. Results Of the 9 patients, IPA diagnosed in two cases and patients with clinical diagnosis in 7 cases. 2 patients without underlying diseases, and the remaining seven eases were the basis of the disease. Clinical manifestations included fever, cough,hemoptysis,chest distress and breathlessness. 6 cases could be found in sputum culture of Aspergillus. G test and the GM test was positive in 5 cases. Two cases of pathological bronchoscopy and special staining consistent with aspergillus. Imaging showed the diversity. All patients were receiving antifungal treatment, 8 cases were followed up,lost in 1 case. Voriconazole is indicated as the treatment of choice in 5 cases ; there were three cases of initial treatment with itraconazole, Mika Fen net or caspofungin was ineffective. And these cases were switching to voriconazole is still an excellent outcome. Conclusion Patients of IPA without agranulocytosis lack of specific clinical manifestations. Early diagnosis and treatment are critical for reducing the mortality of IPA.