慢性阻塞性肺疾病并发侵袭性曲霉菌感染的临床研究

Clinical research on invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary diseases

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的临床特点、高危因素、治疗及转归。方法对医院2006年1月-2011年1月29例COPD合并IPA的临床资料进行回顾性分析。结果 29例曲霉菌属感染的病例中,拟诊11例、临床诊断16例、确诊2例;临床表现为呼吸困难加重25例占86.2%、哮鸣音增多21例占72.4%、发热15例占51.7%等,影像学表现为肺部的炎性渗出、实变、结节、空洞等,但都无特异性;高龄、低蛋白血症、广谱抗菌药物及激素的使用等是肺曲霉菌属感染的危险因素。结论慢性阻塞性肺疾病合并侵袭性肺曲霉菌病缺乏特异性,早期诊断及早期有效合理的治疗,是改善预后的有效手段。

OBJECTIVE To analyze the clinical characteristics,high-risk factors,the treatment and the outcome of invasive pulmonary aspergillosis（IPA） in patients with chronic obstructive pulmonary diseases（COPD）.METHODS The clinical data of 29 patients with COPD and IPA from Jan 2006 to Jan 2011 were retrospectively analyzed.RESULTS Of 29 patients with Aspergillus infections,11 cases were expected to be diagnosed,16 cases were clinically diagnosed,and 2 cases were confirmed.The clinical manifestations were as follows： 25 cases（86.2%） of exacerbation of dyspnea,21 cases（72.4%） with the increase in wheezing sound,and 15 cases（51.7%） of fever,and so on radiological findings were presented as the inflammatory exudation,the consolidation,the tubercle,and the cavity of lungs without specificities,old age,hypoproteinemia,and the use of broad spectrum antibiotics and corticosteroids were the risk factors for Aspergillus infections.CONCLUSION Since the invasive pulmonary aspergillosis with COPD lacks the specificity,early diagnosis and the effective and reasonable treatment are the effective ways to improve the prognosis.