侵袭性声带曲霉病1例并文献复习

Invasive laryngeal aspergillosis: report of one case and review of relevant Chinese literature

目的了解侵袭性声带曲霉病的临床特征。方法复习国内发表的有病理证据的侵袭性声带曲霉病的文献,结合近期收治的1例侵袭性声带曲霉病患者进行分析。结果报道1例侵袭性声带曲霉病,综合文献中该疾病报道作一分析。报道45例患者中6.7%患有糖尿病,4.4%患有慢性阻塞性肺疾病,均无免疫受损基础疾病。主要危险因素是广谱抗生素(88.4%)和糖皮质激素(55.6%)的使用。主要症状包括声嘶、干咳、咽痛、失声等。45例均经喉镜局部组织活检病理诊断。34例(75.6%)经抗真菌药物治疗有效,包括伊曲康唑、两性霉素B及伏立康唑。11例(24.4%)患者未治疗或仅行创伤较小的膜样物剥脱术,也获得了痊愈。长期随访复发率低(2.2%),并发症少(4.4%)。结论侵袭性声带曲霉病可发生于无免疫受损疾病的宿主,广谱抗生素和糖皮质激素的使用是常见危险因素,确诊依赖于喉镜下组织活检及培养,抗真菌药物治疗效果好,部分患者可自愈,复发率低,并发症少。

Objective To describe the epidemiology and etiological factors of invasive laryngeal aspergillosis and propose appropriate diagnostic and therapeutic policies for this disease. Methods One case of invasive laryngeal aspergillosis was presented and another 44 cases reported in Chinese literatures were reviewed. Results Twenty-one male and twenty-four female patients were included （mean age of 39~ 15 years）. Underlying disease was found in some patients, including diabetes in 6.7% of the patients, and chronic obstructive pulmonary disease in 4.4% of the patients. The major risk factors were antibiotic abuse （88.4%） and corticosteroid use （55.6%）. The main symptoms included hoarseness, dry cough, sore throat and loss of voice. All cases were diagnosed by histological study of laryngoscopic biopsy specimen. Thirty-four patients （75.6%） received antimycotic treatment resulting in good results. The treatments included itraconazole, amphotericin B and voriconazole. Eleven patients （24.4%） did not receive drug treatment or only underwent minimally invasive surgery. However, all these eleven patients were cured. During 6-month follow-up, only one case （2.2%） relapsed and two cases （4.4%） had complications. Conclusions Invasive laryngeal aspergillosis can occur in imrnunocompetent patients. The risk factors include antibiotic and steroid abuse. The diagnosis of this disease is dependent on histological study of the laryngoscopic biopsy specimen. Antifungal agents can cure this disease with low relapse rate and fewer complication. Some patients can fully recover spontaneously.