肺曲霉菌病的诊治分析

Diagnosis and treatment of pulmonary aspergillosis

目的探讨肺曲霉菌病的临床特征、影像学特点、诊断和治疗方法,提高对该病的认识。方法回顾性分析2003—2013年昆山市第一人民医院收治的肺曲霉菌病患者58例的临床资料。结果 58例患者中,仅28例初步诊断考虑有肺曲霉菌感染,19例误诊为肺癌或肺结核;26例经手术治疗,32例为内科保守治疗;53例治疗后好转,5例患者死亡。结论肺曲霉菌病诊断困难,且常需与支气管哮喘、支气管扩张、肺结核及肺癌等疾病相鉴别。肺曲霉菌球经手术切除及抗真菌药物治疗后预后较好;变应性支气管肺曲霉菌病需长期激素联合抗真菌治疗;而侵袭性肺曲霉菌病病死率较高,预后较差。

Objective To explore the clinical characteristic,imaging features,diagnosis and therapies of pulmonary aspergillosis,to improve the cognition of pulmonary aspergillosis. Methods The clinical data of 58 pulmonary aspergillosis patients were retrospectively analyzed from 2003 to 2013 in the First People＇s Hospital of Kunshan. Results In the 58 patients,only 28 cases were primary diagnosed,19 cases were misdiagnosed as tuberculosis or lung cancer; 26 cases were treated with operation,32 cases were treated with conservative treatmen; 53 cases were improved after treatment,5 patients died. Conclusion Clinical diagnosis of pulmonary aspergillosis is difficult,needs to differentiate from bronchial asthma,bronchiectasis,pulmonary tuberculosis and lung cancer. The prognosis of aspergilloma patients is good after operation resection and antifungal therapy; allergic bronchopulmonary aspergillosis patients need long-term hormone combined with antifungal therapy; the mortality of invasive pulmonary aspergillosis patients is high,has a poor prognosis.