慢性阻塞性肺疾病并侵袭性肺曲霉菌感染临床特征分析

The Primary Study for Clinical Features of Invasive Pulmonary Aspergillosis in Patients with Chronic Obstructive Pulmonary Disease

目的研究慢性阻塞性肺疾病(COPD)并侵袭性肺曲霉菌病(IPA)患者的临床特征及治疗转归。方法回顾性分析2010年8月至2012年12月新疆自治区人民医院收治的11例COPD(3级或4级)并IPA患者,对其临床特征及治疗转归进行分析。结果 11例患者中3例经肺组织活检临床确诊为IPA,8例为临床诊断IPA;11例患者中曲霉菌经分离并鉴定,其中6例为烟曲霉菌感染,3例为黑曲霉菌感染,另外2例未鉴定出真菌类型;5例患者进入ICU治疗,其中4例接受机械通气治疗,胸部X线及胸部CT最常见的表现是渗出,X线表现为7例、胸部CT表现为8例;两性霉素B是所有患者治疗的首选,5例患者在两性霉素B治疗后口服伏立康唑治疗并出院,6例患者死亡。结论对于重度、极重度COPD患者伴随有急性加重的呼吸困难、一般状况差、应用广谱抗生素及激素治疗下新近出现的肺部渗出影时,IPA应当作为鉴别诊断,早期诊断及治疗尤为重要,将大大降低病死率。

Objective To investigate the clinical characteristics and treatment responses of invasire pulmonary aspergillosis（ IPA ） in patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 11 cases of invasive pulmonary aspergillosis in patients with COPD （ Grade 3 or 4）from Oct. 2010 to Dec. 2012 in People＇s Hospital of Xinjiang were retrospectively analyzed for the clinical features and therapeutic outcomes. Results Aspergillus hyphae were detected by lung biopsy in three out of 11 patients and defined as proven IPA ; the other eight patients were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. Five patients received ICU treatment,and four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography （CT） was infiltration （ respectively 7 cases, 8 cases）. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voficonazole after amphotericin B therapy. Six patients died before the treatment was completed. Conclusion IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation,poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids. Early diagnosis and treatment are particularly important, which would greatly reduce the mortality.