肺曲菌球病63例临床分析

Clinical analysis of 63 cases of pulmonary aspergilloma

目的探讨肺曲菌球病的临床特征和治疗方案。方法回顾性分析2008．1—2014．10年收治63例病理确诊肺曲菌球病患者的临床诊治情况。结果HCT〈37％24例，血清前白蛋白（PA）〈200mg／L 20例，LY〈1．5×10^9／L19例；肺结核空洞22例，支气管扩张症19例，6例无明确基础疾病；咳嗽46例，咯血59例，大咯血29例。典型影像学表现48例，误诊4例，漏诊11例；可见纵隔淋巴结23例，短径小于1cm，淋巴结活检提示反应性增生。病灶位于左肺上叶17例，右肺上叶29例。肺功能检查：总弥散量低于比弥散量（t=-9．422，P〈0．001）；均行外科手术治疗；58例随访影像学未见复发；大咯血与相关危险因素的Logistic分析，肺结核空洞OR=6．113，P=0．008，空洞或空腔内长径OR=2．410，P=0．004。结论肺曲菌球病咯血和咳嗽为主要症状；病灶多位于双肺上叶，影像学特征典型，大咯血患者的曲菌球长径、空洞或空腔长内径长于非大咯血患者；弥散功能有一定特征性；首选手术治疗；肺结核空洞和空洞或空腔内长径是大咯血的危险因素。

Objective To investigate the clinical features and methods of treatment of pulmonary aspergilloma （PA）. MethodsThe clinical date of 63 cases of pulmonary aspergilloma from 2008.1 to 2014.10 were retrospec-tively analyzed. Results There were 24 cases of HCT 〈 37% , 20 cases of PA 〈 200 mg/L, and 19 cases of LY 〈 1.5 ×10^9/L. There were 22 cases with pulmonary tuberculosis cavity, 19 cases with bronchiectasis, and 6 cases without definite underlying diseases. 46 cases had cough, 59 cases of hemoptysis and 29 cases of massive haemoptysis. The imaging features showed typical display of pulmonary aspergilloma in 48 cases, 4 cases were misdiagnosed, and 11 cases were missed diagnosed. The mediastinal lymph nodes, which minor axis were less than 1 cm in size, were found by CT test in 23 cases. The histology showed reactive hyperplasia. In 17 cases PA were found in left upper lung lobes, and in 29 cases PA were found in left upper lung lobes. DLCO was lower than DLCO/VA （ t = - 9. 422, P 〈 0. 001 ）. All patients with pulmonary aspergilloma underwent surgical treatment. In 58 cases, re-appearance of aspergilloma was not found by CT test. The logistic analysis revealed that tuberculosis cavity （ odds ratio 6. 113, P = 0. 008） and long diameter of cavity wall （odds ratio 2. 410, P = 0. 004） were the risk factors of massive hemoptysis. Conclusion The principal symptoms of pulmonary aspergilloma are cough and hemoptysis. The PA is found in upper lung lobes usually. The imaging features and lung diffusion test is typical. The patients who undergo massive haemoptysis have longer long diameter of cavity wall and PA. The standard treatment is surgical removal of the aspergilloma. The tuberculosis cavity and long diameter of cavity wall are the risk factors of massive hemoptysis.