侵袭性肺真菌感染的临床分析

Clinical analysis of invasive pulmonary fungal infections

目的对病理确诊的侵袭性肺真菌感染(IPFI)病例进行临床分析,了解IPFI患者的危险因素、临床及影像特点,加深对IPFI的认识,提高临床诊治水平。方法回顾分析1997-2014年医院病理确诊的IPFI患者32例,对资料记载的相关危险因素、临床表现、病原学、影像学表现及病理结果,比较继发性和原发性IPFI的临床特点。结果 IPFI临床表现不特异,继发性IPFI年龄大,更多表现为发热、咳嗽和/或咳痰、呼吸困难;原发性IPFI影像学表现以结节或肿块为主;32例确诊IPFI患者,25例继发性IPFI患者中13例为曲霉菌感染;7例原发性IPFI中6例隐球菌感染;8例死亡病例均为继发性IPFI。结论 IPFI以曲霉菌感染为主,临床表现及影像学不特异;继发性IPFI患者年龄大、病死率高,原发性IPFI临床症状少,需尽早行侵袭性治疗协助诊断。

OBJECTIVE To investigate the cases of invasive pulmonary fungal infections （IPFI） diagnosed by biop- sy, and understand the risk factors, clinical and imaging characteristics of IPFI, and further understand IPFI, so as to improve the ability in diagnosis of IPFI. METHODS A total of 32 patients of IPFI diagnosed by biopsy from Dec. 1997 to Dec. 2014 in Beijing Hospital were retrospectively analyzed. The clinical information of IPFI was ana- lyzed retrospectively, including risk factors, clinical manifestation, imaging and pathological characteristics. The clinical characteristics of secondary IPFI and primary IPFI were compared. RESULTS The IPFI clinical manifesta- tions were not speei{ie. The age of the secondary IPFI group was older, and the symptom~ mere mostly presented as fever, cough and/or expectoration, and dyspnea in the secondary IPFI group. The common imaging features were nodules or masses in the primary IPFI group. Among 32 cases of IPFI patients, there were 25 cases of sec- ondary IPFI, in which 13 cases were infected with Aspergillus, and 7 cases of primary IPFI, in which 6 cases were infected with Cryptococcus. Eight eases of death were all secondary IPFI. CONCLUSION The major patho- gen of IPFI is Aspergillus. The symptoms and imaging features of IPFI are non-specific. The secondary IPFI has old age, and tends to be highly fatal. The symptoms in the primary IPFI group are less than those of the secondary IPFI group. Early diagnosis with surgical intervention may be beneficial for these patients.