陈旧性肺结核合并肺曲霉菌病75例临床分析

Clinical analysis of 75 cases of patients with old pulmonary tuberculosis combined with pulmonary aspergillosis

目的:分析陈旧性肺结核合并肺曲霉菌病的临床特征和诊治办法。方法:回顾性分析我院2000至2009年收治肺结核合并肺霉菌病75例。分析患者的临床特征、影像学表现、实验室检查及治疗方法。结果:陈旧性肺结核合并肺曲霉菌病的患者中51%合并糖尿病,35%合并慢阻肺,90%的病人有咯血症状,68%病人有胸闷症状5,2%咳黄浓痰,40%咳灰黑色痰液,73%的病变位于上肺,58.7%的病人影像学有典型晕轮征、新月征4,1.3%的病人有不规则团块状阴影,未见明显新月征,纤支镜活检病理阳性率为20%,灌洗液发现曲霉菌的有51%。结论:陈旧性结核尤其是合并糖尿病、AECOPD等基础疾病的患者再次出现咳嗽、咳痰(尤灰黑色痰液)、咯血、胸闷、发热等或影像学上出现晕轮征,应高度考虑继发真菌感染的可能,并积极给予纤支镜检查。

Objective：To analyze the clinical features and treatment of the old Pulmonary tuberculosis combined with pulmonary aspergillosis. Methods：A retrospective analysis was carried out among 75 cases of patients with old Pulmonary tuberculosis combined with pulmonary aspergillosis. Results：In the 75 cases,there were 51% complicated with diabetes mellitus,35% complicated with COPD,90% who had symptoms of hemoptysis,68% who had symptoms of chest tightness,52% who had yellow thick sputum and 40% who had gray black sputum respectively.The imaging of 58.7% patients showed typical halo sign or moon sign and 41.3% showed irregular agglomerate shadow.No obvious crescent sign was found.In the all cases,73% of the lesions located on the upper lungs.The positive rate of bronchoscopy biopsy was 20%,and aspergillums were found in 51% of the bronchoscope fluid. Conclusion：If the old Pulmonary tuberculosis patients,especially with the underlying diseases such as diabetes mellitus and COPD have the symptoms of cough,sputum production（especially gray and black sputum）,hemoptysis,chest tightness,fever,or radiographic halo sign again,the possibility for them considered as the secondary fungal infection is utmost.And the bronchoscopy should be given actively.