2例原发性侵袭性肺曲霉菌病患者的临床分析及其对策

Analysis on Clinical Diagnosis in 2 Patients with Primary Invasive Pulmonary Aspergillosis and Its Countermeasures

目的:分析原发性侵袭性肺曲霉菌病患者的临床特点及其治疗对策。方法:采用回顾性分析法,对2例原发性侵袭性肺曲霉菌病患者的临床资料,分析其临床特点及其治疗对策。结果:2例原发性侵袭性肺曲霉菌病患者均以发热、咳嗽为主要症状,经CT检查结果可见肺部多发结节影或斑片影,血清学检查结果未见异常;支气管镜检查结果显示1例患者镜下可见主支气管、左右主支气管及各叶、段内大量棕黄色黏稠分泌物,黏膜广泛充血水肿、粗糙糜烂,表面可见散在灰白色坏死物附着;灌洗液分枝杆菌培养呈阴性;灌洗液培养提示霉菌、嗜血杆菌和念珠菌未生长;支气管镜分泌物培养提示曲霉菌生长;另1例患者未行电子气管镜检查;2例均因病情进展迅速、诊断困难最终死亡。结论:正常宿主中IPA临床症状、影像学表现无特异性,血清学检查无异常表现,气管镜检查和分泌物培养有助于确诊曲霉菌病;选用广谱抗曲霉菌药是治疗该病的首选药物。

Objective： To analyze the clinical diagnosis in 2 patients with primary invasive pulmonary aspergillosis（IPA） and its countermeasures. Methods： Clinical data of 2 patients with primary IPA were analyzed retrospectively. Its clinical characteristics and treatment strategies were analyzed. Results： The main symptom of 2 patients is fever and cough. CT examination showed multiple nodules and patches shadows in the lungs. No abnormality was found in serological examination. Bronchoscopy, in 1 case,large amount of yellowish brown sticky secretions were seen in the left and right main bronchi and ecery segment of the main trachea.extensive mucosal congestion,edema,rough erosion,the surface scattered attached to the gray sphacelus. Mycobacteria were negative for lavage fluid culture. The culture of the lavage fluid indicated that the mold did not grow, the Haemophilus did not grow, and the Candida did not grow. Bronchoscopic secretion culture suggested Aspergillus spp. growth. 1 case was not examined by bronchoscopy. 2 cases died due to rapid progression of the disease（difficult diagnosis）. Conclusion： The clinical symptoms and imaging findings of IPA were not specific in normal host and no abnormality was found in serological examination. Bronchoscopy is helpful for the diagnosis of the disease. After the diagnosis of aspergillus, strong and broad-spectrum anti-aspergillus drugs should be selected.