慢性阻塞性肺疾病合并肺曲霉菌病7例临床分析

Chronic obstructive pulmonary disease complicated with invasive pulmonary aspergillosis:report of 7cases

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌(IPA)的临床特点。方法回顾性分析COPD合并IPA患者7例的临床资料。结果 7例患者中确诊2例、临床诊断5例;长期应用糖皮质激素史者6例,使用广谱抗生素史者7例,有创机械通气者1例;最常见症状是呼吸困难、咳嗽咯痰、肺部出现干湿哕音;痰培养曲霉素6例,肺活检、尸检出曲霉菌各1例;联合用卡泊芬净及伏立康者4例,单用伏立康2例,单用伊曲康唑1例;治疗好转3例,死亡4例。结论激素和广谱抗生素的使用是COPD继发IPA的高危因素;应结合临床表现、胸部CT、病原学及血清学检查对IPA进行早期诊断。

Objective To study the clinical characteristics of invasive pulmonary aspergillosis （IPA） in patients with chronic obstructive pulmonary disease （COPD）. Methods Clinical data about 7 patients of COPD complicated with IPA were retrospectively analyzed. Results 2 patients had proven IPA and 5 patients had probable IPA. 6 patients had long-term med ication history of corticosteroid,7 patients had long-term medication history of broad spectrum antibiotic, 1 patient used invasive mechanical ventilation. The most common symptoms were dyspnea, cough, pulmonary rales, aspergillosis was found in sputum culture in 6 cases ,autopsy in 1 case and lung biopsy in 1 case,4 cases were treated with combined caspofungin and voriconazole,2 cases with only voriconazole, 1 case with only itraconazole. 7 patients were received anti-fungal therapy, 3 patients could be treated effectively while 4 patients died. Conclusion IPA in patients with COPD was associated with high doses of corticosteroid and broad spectrum antibiotic. Diagnosis is usually based on a combination of clinical features, radiological findings, microbiological results and serological information.