不同免疫状态下肺曲霉菌感染24例临床分析

Pulmonary aspergillosis:clinical analysis in immunocompetent and immunocompromised patients

目的探讨不同免疫状态下肺曲霉菌感染的临床特点、治疗及预后因素。方法回顾性分析2000年1月至2010年3月北京协和医院有组织病理或者培养证据确诊肺曲霉菌感染的24例病例资料。结果免疫正常组7例,免疫缺陷组17例。和免疫正常组相比,免疫缺陷组病程短(<1个月更多见,88.2%对14.3%),发热症状常见(88.2%对28.6%),咯血少见(11.8%对71.4%),差异均有统计学意义。免疫正常组影像表现为单发病灶者占57.1%高于免疫缺陷组患者(11.8%,P<0.05)。免疫缺陷组主要用药物治疗,免疫正常组中57.1%手术切除。免疫正常组均存活;免疫缺陷组病死率为52.9%,并且死亡可能与存在严重合并症,免疫缺陷宿主因素不能纠正以及外周血淋巴细胞下降等因素有关。结论不同免疫状态的肺曲菌感染患者临床表现及影像表现不同。免疫缺陷的肺曲霉菌感染患者预后差,其中有严重合并症、宿主因素不能纠正、外周血淋巴细胞下降可能与预后不良有关。治疗应根据患者的免疫状态而有所不同。

Sciences Peking Union Medical College, Beijing 100730, China Abstract：Objective To analyze the clinical characteristics and treatment of pulmonary aspergillosis in immunocompetent and immunocompromised patients. Methods Patients diagnosed as proven pulmonary aspergillo- sis in Peking Union Medical College Hospital from Jan 2000 to Mar 2010 were ineluded in this analysis. Clinical characteristics were studied retrospectively. Results 24 patients were included,7 immunocompetent and 17 im- munocompromised patients. Fever Was more common in immunocompromised patients than immunocompetent pa- tients （88.2% vs 28.6% ,P 〈 0. 05 ）, While hemoptysis was more common in immunocompetent patients than in immunocompromised patients（71.4% vs 11.8% ,P 〈 0. 05 ）. A single or localized lesion on CT scan was more common in immunoeompetent patients than in immunocompromised patients （57. 1% vs 11.8 % ,P 〈 0. 05 ）. Surgi- cal resection was performed in 5 （71%）immunocompetent patients; While the immunocompromised patients received antifungal drug therapy except 1 patient. The prognosis of immunocompetent patients was better than immu- nocompromised patients. Severe complications, no improvement of immunocompromised factors and decreased lym- phocyte may correlated with prognosis in immunocompromised patients. Conclusion The clinical manifestations and imaging findings of pulmonary aspergillosis was different in immunocompetent and immunocompromised patients. There were benign clinical course in immunocompetent patients. Treatment of pulmonary aspergillosis should be sorted according to their immune status.