肺癌继发侵袭性肺真菌病10例临床分析

Invasive pulmonary mycosis secondary to lung cancer： clinical analysis of 10 cases

目的探讨肺癌继发侵袭性肺真菌病（IPM）的临床特征。方法回顾性分析2010年2月至2012年1月北京朝阳医院．北京呼吸疾病研究所收治的10例肺癌继发IPM患者的临床表现、影像学特征、微生物学检查、治疗及预后资料。结果10例肺癌继发IPM患者，平均年龄（64．5±14．7）岁，70岁以上的老年患者5例。其中非小细胞肺癌8例，小细胞肺癌2例，均为临床分期Ⅳ期患者，所有患者均接受过抗肿瘤治疗。IPM临床诊断7例，拟诊3例，以曲霉菌和念珠菌感染较多见。肺癌继发IPM时主要临床表现为呼吸困难（8／10）、发热（8／10）、咯血（5／10）及胸痛（5／10）。胸部CT主要表现为斑片状渗出影和（或）实变影（10／10），2例伴空洞形成。10例患者均接受抗真菌治疗，7例治疗显效，3例老年患者死亡。结论老年晚期肺癌患者接受抗肿瘤治疗后易继发IPM，且死亡率高。应早期诊断并及早应用有效的抗真菌药物治疗。

Objective To investigate the clinical characteristics of invasive pulmonary mycosis（IPM） secondary to lung cancer. Methods The clinical data of 10 cases with IPM secondary to lung cancer in Beijing Institute of Respiratory Diseases from February 2010 to January 2012 were respectively analyzed. Results Average age of 10 patients was （64.5 ± 14.7） years, and 5 cases were older than 70 years of age. There were 8 patients with non-small cell lung cancer, and 2 cases with small cell lung cancer. All the patients presented with clinical stage IV disease and received antitumor therapy. Definite IPM diagnosis was established in 7 cases and possible diagnosis in 3 cases. Aspergillus and candida were common pathogenic fungi in this group. The symptoms of IPM were mostly presented as dyspnea （8/10）, fever （8/10）, hemoptysis （5/10） and chest pain （5/10）. The most frequent chest CT features included infiltrates and （or） consolidations （10/10）, and cavities were found in 2 cases. All patients received antifungal therapy. Seven cases were improved and 3 cases died. Conclusion The elderly and advanced patients with lung cancer are more prone to secondary IPM after receiving antitumunor therapy, which has a high mortality rate. Early diagnosis with prompt potent antifungal agents may be beneficial to these patients.