原发性与继发性侵袭性肺真菌病临床特点分析

Analysis of clinical characteristics between the primary and secondary invasive pulmonary fungal diseases

目的对比原发性及继发性侵袭性肺真菌病(IPFD)的临床特点的差异,提高IPFD的诊断及治疗水平。方法回顾分析2014年1月至2018年1月郑州大学第一附属医院病理确诊的151例IPFD临床资料,分为原发组与继发组,比较两组临床症状、影像学、治疗及预后的差异。结果151例IPFD中原发性有69例(45.7%),继发性82例(54.3%),二者在发热、影像学表现结节肿块型、混合型、病灶数目、累及肺叶、空洞、纵隔淋巴结肿大、胸腔积液比较差异均有统计学意义(P值均<0.05)。继发性IPFD最常的基础疾病为糖尿病,41例,占50%。151例病理诊断中有89例经CT引导下肺穿,32例经手术,30例经支气管镜。药物治疗115例(86.1%),胸腔镜手术治疗32例(21.2%)。原发性IPFD治疗,有效率为92.8%。继发性IPFD治疗有效率为86.6%。结论原发性IPFD发病率较前升高,与继发性相比多表现为单叶单发结节肿块,应及早行肺活检以明确诊断,避免漏诊、误诊。

Objective To improve the diagnosis and treatment level of invasive pulmonary fungal diseases by comparing the clinical characteristics between the primary and secondary invasive pulmonary fungal diseases.Methods A total of 151 patients of IPFD diagnosed by biopsy from January 2014 to January 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.They were divided into primary and secondary,to compare manifestation,imaging,treatment and prognosis.Results In 151 cases of IPFD,69 cases(45.7%)were primary and 82 cases(54.3%)were secondary.There were statistically significant in fever,imaging findings of nodular or mass type,mixed type,number of lesions,involving lung lobe,halo sign,mediastinal lymph node enlargement,and pleural effusion(P<0.05).The most common underlying disease of secondary IPFD was diabetes,with 41 cases accounting for 50%.Pulmonary fungal infection was confirmed by pneumonectomy 32 cases,CT-guided percutaneous transthoracic biopsy 89 cases,transbronchial lung biopsy 30 cases.115 cases were treated by drugs,32 cases treated by thoracoscope surgery.The treatment efficiency of primary IPFD was 92.8%,the secondary was 86.6%.Conclusions The incidence of primary IPFD is higher than that of the former,compared with the secondary,its imaging often presentes one lobe and single nodular involving.Pathological diagnosis should be performed early to avoid missed or misdiagnosed.