12例系统性红斑狼疮合并侵袭性肺曲霉菌病的临床分析

Clinical Analysis of 12 Cases of Invasive Pulmanory Aspergillosis with Systemic Lupus Erythematosus

目的:探讨系统性红斑狼疮(SLE)合并侵袭性肺曲霉病(IPA)的危险因素、临床特征、病原学及影像学检查特点。方法:对宜昌市中心人民医院2012年1月～2017年12月12例SLE合并IPA的患者临床资料进行回顾性分析。结果:危险因素:长期使用激素9例(75.00%),广谱抗生素10例(83.33%),免疫抑制剂5例(41.67%)。临床表现无特异性。病原学检查:血清1,3-β-D-葡聚糖(G)实验阳性7例(58.33%),血清曲霉菌半乳甘露聚糖(GM)实验阳性5例(41.67%);5例送检肺泡灌洗液(BALF),4例BALF-GM实验阳性(80.00%),2例BALF培养阳性(40.00%),1例保护性毛刷(PSB)取标本找到曲霉菌菌丝(20.00%)。影像学检查:初始肺部CT呈现结节样改变7例(58.33%),其中2例可见晕征(16.67%),1例可见肺内多发空洞(8.33%);复查肺部CT,病灶进展新出现晕征3例(25.00%),多发空洞及空气新月征4例(33.33%)。转归:7例好转出院(58.33%),5例最终死亡(41.67%)。结论:SLE并发IPA患者临床死亡率高,长期使用激素、抗生素和免疫抑制剂是SLE并发IPA的重要危险因素,积极进行BALF-GM检测和动态关注肺部CT病灶的改变,有助于SLE并发IPA的早期诊断。

Objective:To investigate the characteristics of invasive pulmonary aspergillosis(IPA)with systemic lupus erythematosus(SLE),including risk factors,clinical features,etiological and imaging features.Methods:Clinical data of 12 cases of IPA with SLE were analyzed retrospectively in the Yichang central people’s hospital from January 2012 to December 2017.Results:The risk factors for IPA with SLE included prolonged use of steroids(9cases,75.00%),broad spectrum antibiotics(10cases,83.33%)and immunosuppressant(5cases,41.67%).There was no specific clinical manifestation in IPA with SLE.Seven cases were positive in serum 1,3-β-D-glucan(G)assay(58.33%)and 5cases were positive in serum galactomannan(GM)assay(41.67%).Bronchoalveolar lavage fluid(BALF)was tested on 5patients.There were 4cases positive in BALF-GM assay(80.00%),2cases positive in BALF culture(40.00%)and 1case with aspergillus mycelia confirmed by protective specimen brush(PSB)(20.00%).In the initial lung CT examination,there were 7cases performed with nodular changes(58.33%),including 2cases with halo around the nodule(16.67%)and 1case with multiple cavities(8.33%).In addition,3cases with halo(25.00%)and 4 cases with multiple cavities and air crescent(33.33%)were occurred in lung CT re-examination.In the end,there were 7patients recovered and discharged(58.33%),while 5patients eventually died(41.67%).Conclusion:Patients of IPA with SLE have high clinical mortality.The important risk factors are long-term use of steroids,antibiotics,and immunosuppressants.Timely and effective BALF-GM test,as well as pulmonary CT examination,plays a helpful role in early diagnosis of IPA with SLE.