侵袭性肺真菌感染的临床与病原学分析

Clinical and Etiology Research of Invasive Pulmonary Fungal Disease

目的探讨侵袭性肺真菌感染的流行病学特点、易患因素、影像学特征、诊断、治疗和预后。方法应用回顾性调查的方法对2005年1月至2012年2月非重症监护室经病理诊断为肺真菌病患者90例进行分析。结果 90例患者中,病原体分布占前4位的为曲霉、隐球菌、毛霉菌、组织胞浆菌,所占比例分别为62.2%、20.0%、6.7%及6.7%。其中96.7%(87/90)的病例患有基础疾病,以慢性阻塞性肺疾病(COPD)、肺结核、糖尿病多见。肺部真菌感染的临床症状以咳嗽(74.4%)、咳痰(41.1%)多见,但不具有特异性。最常见的危险因素为长期使用广谱抗生素(54.4%)。胸部影像学表现有肿块型25例(27.8%)、结节型15例(16.7%)、肺炎型22例(24.4%)、空洞型22例(24.4%)、曲霉球型6例(6.7%)。病理检查前临床诊断为侵袭性肺真菌感染的47例,其余43例活检前均初诊为其他疾病,初诊符合率为52.2%。31例(34.4%)经外科手术切除,随访2年均无复发;56例(62.2%)经抗真菌治疗,出院时43例(76.8%)痊愈或好转,3例(5.4%)无变化,10例(17.8%)死亡,3例(3.3%)拒绝任何治疗。结论侵袭性肺真菌感染以肺曲霉病多见,最常见的基础疾病为COPD、肺结核、糖尿病。长期使用广谱抗生素可能是常见诱因。确诊有赖于病理学依据,采用外科手术治疗的患者预后最佳。

Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive puhnonary fungal infection （IPFI）. Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases（62. 2% ）, Cryptococcus in 18 cases（20.0% ） ,Mucormycosis in 6 cases（6. 7% ）, and Histoplasma in 6 eases（6.7% ）,etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients （54.4%） received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases（27. 8% ） ,nodule lesions type in 15 cases（ 16. 7% ） ,lung consolidation type in 22 cases（24. 4% ） ,cavity type in 22 cases（24.4% ）, aspergilloma type in 6 cases（6. 7% ）. 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2%. 31 cases （ 34. 4% ） underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases （62. 2% ） received systemic anti-fugal therapy, and 43 cases （76. 8% ） were cured or significantly improved. 3 cases （ 3.3% ） refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-term and broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.