29例非中性粒细胞缺乏患者侵袭性肺曲霉病临床分析

Invasive pulmonary aspergillosis in non-neutropenic patients:A clinical analysis of 29 cases

目的分析非中性粒细胞缺乏患者侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的临床特点。方法对本院2011年1月-2013年12月呼吸科29例非中性粒细胞缺乏IPA患者的临床特点进行回顾性研究。结果 29例IPA患者中,确诊12例,临床诊断17例。基础疾病以慢性肺疾病最常见(11例),其次为糖尿病、无基础疾病(各7例)。从发病到诊断平均16.5d。临床症状无特异性,胸部CT以渗出影最常见。结论对于咳嗽、咳痰并有呼吸困难,PCT正常,CT表现为渗出影,特别是伴有肺部基础疾病,经广谱抗生素和糖皮质激素治疗无效的非中性粒细胞缺乏患者,应高度怀疑IPA可能。

Objective To investigate the clinical characteristics of invasive pulmonary aspergillosis （IPA） in non-neutropenic patients. Methods Clinical and imaging characteristics about 29 patients with proven and probable IPA admitted to department of respiratory diseases from January 2011 to December 2013 were retrospectively analyzed. Results Patients were classified into proven IPA group （n=12） and probable IPA group （n=17）. The most common underlying disease of patients with IPA was chronic respiratory disease （n=11）, diabetes mellitus and no basic diseases, each occurred in 7 cases. The average time from onset to diagnosis was 16.5 days. Clinical symptoms were nonspecific in non-neutropenic patients with IPA. The most common chest CT scan findings of patients with IPA were infiltrates. Conclusion IPA should be taken into account in the differential diagnosis particularly in non-neutropenic patients with dyspnea, cough, sputum, PCT normal values and a new pulmonary in filtrate that are irresponsive to broad-spectrum antibiotics and steroids.