侵袭性肺曲霉病22例临床分析

Clinical analysis of 22 cases of invasive pulmonary aspergiilosis

目的分析侵袭性肺曲霉病（IPA）的临床特征，提高对IPA的认识。方法回顾性分析河南省人民医院2000年6月至2010年6月22例IPA患者的临床资料。结果22例IPA患者有21例合并有基础性疾病（95．5％）。咳嗽、咳痰占90．9％，发热占59．1％，闷气、呼吸困难占50．0％，咯血占45．5％，胸痛占31．8％；胸部影像学表现：双肺多发类圆形块影或结节占54．5％，两肺斑片影伴空洞占31．8％，支气管肺炎型占9．1％，楔形肺实变占4．5％。22例IPA患者确诊8例（36．4％），临床诊断14例（63．6％）。20例患者接受抗真菌治疗，有效率为65．0％。结论肺曲霉病患者多有基础疾病，胸部影像学表现以双肺多发结节影、空洞为主，早期诊断治疗可降低病死率。

Objective To analyze the clinical features of invasive pulmonary aspergillosis （IPA） , and deepen our understanding of the disease. Methods Clinical datas of 22 cases of IPA in our hospital from June 2000 to June 2010 were retrospectively analyzed. Results Twenty - one patients （95.5%） suffered from underlying diseases in 22 IPA cases. The incidence of symptoms was 90.9% for productive cough, 59. 1% for fever, 50. 0% for breathlessness or dyspnea, 45.5% for haemoptysis, 31.8% for chest pain. By chest radiography, bilateral multiple pulmonary similar round mass or nodules was found in 54.5%, bilateral pulmonary infiltrates with mutiple cavitations in 31.8%, bronchopneumonia in 9.1% ,consolidation like wedge in 4.5%. Among the 22 subjects, 8 eases（36.4% ） were proven and 14 cases（63.6% ） were probable IPA. The effective rate of 20 patients receiving anti -fugus therapy was 65.0%. Conclusions A majority of ivasive pulmonary aspergillosis developed from underlying diseases, bilateral muhifoeal nodules and cavitions could be most common radiological eharacterisie, early diagnosis and treatment are critical for reducing the mortality of IPA.