肺结核并发肺曲霉感染的临床特征及诊疗研究

Clinical characteristics,diagnosis and treatment of pulmonary tuberculosis complicated with pulmonary aspergillus infection

目的分析肺结核并发肺曲霉感染的临床特征及临床诊断和治疗情况。方法回顾性分析本院2019年1—12月期间肺结核并发肺曲霉感染患者76例的临床资料,分析肺结核并发肺曲霉感染的临床特征、诊断及治疗情况。结果76例肺结核并发肺曲霉感染患者中,合并慢性阻塞性肺疾病占比为30.26%(23/76),合并糖尿病占比23.68%(18/76),合并支气管扩张占比15.79%(12/76),合并支气管哮喘占比11.84%(9/76),合并粒细胞缺乏症占比10.53%(8/76),合并尘肺病占比7.89%(6/76);肺结核并发肺曲霉菌患者的临床表现中发热占比35.53%(27/76),咳嗽、咳痰占比100.00%(76/76),咯血占比69.74%(53/76),胸痛占比14.47%(11/76),呼吸困难占比5.26%(4/76),无症状表现占比6.58%(5/76)。经CT诊断,肺结核并发肺曲霉感染的CT影像可见结节、实变、空洞、新月征表现,其中实变多发于单侧及上肺,结节多见于单侧,空洞、新月征多见于上肺。CT检查对肺结核并发肺曲霉的检出率为86.84%(66/76);痰培养的检出率为75.00%(57/76);病理检查的检出率为100.00%(76/76)。76例患者均给予抗结核治疗,其中共12例患者行手术切除病灶治疗,17例行支气管镜介入治疗,并均于术后给予抗菌药物治疗,34例给予支气管镜下灌注抗菌药物治疗,13例给予抗菌药物治疗。所有患者均于治疗3个月后进行复诊,复诊中仅单纯应用抗菌药物治疗患者中出现2例病情加重情况,其余患者并未发现曲霉菌感染复发、病情恶化情况。结论肺结核并发肺曲霉感染存在多种易感因素,临床表现多以咯血、咳痰咳嗽等症状呈现,影像学特征及临床表现不具备典型性,病理检查为该病症诊断的金标准,而临床上治疗该病症时应依据患者自身需求及病情,合理制定治疗方案。

Objective To analyze the clinical characteristics,clinical diagnosis and treatment of pulmonary tuberculosis complicated with pulmonary aspergillus infection.Methods The clinical data of 76 patients with pulmonary tuberculosis complicated with pulmonary aspergillus infection in our hospital from January 2019 to December 2019 were retrospectively analyzed.The clinical characteristics,diagnosis and treatment of pulmonary tuberculosis complicated with pulmonary aspergillus infection were analyzed.Results Among 76 patients with tuberculosis complicated with pulmonary aspergillus infection,the proportion of chronic obstructive pulmonary disease was 30.26%(23/76),the proportion of diabetes was 23.68%(18/76),the proportion of bronchiectasis was 15.79%(12/76),the proportion of bronchial asthma was 11.84%(9/76),the proportion of agranulocytosis was 10.53%(8/76),the proportion of pneumoconiosis was 7.89%(6/76).In the clinical manifestations of patients with pulmonary tuberculosis complicated with pulmonary aspergillus infection,the proportion of fever was 35.53%(27/76),the proportion of cough and expectoration was 100.00%(76/76),the proportion of hemoptysis was 69.74%(53/76),the proportion of chest pain was 14.47%(11/76),the proportion of dyspnea was 5.26%(4/76),and the proportion of asymptomatic manifestations was 6.58%(5/76).The CT images of pulmonary tuberculosis complicated with pulmonary aspergillus infection showed nodules,consolidation,voids,and crescent signs.Among them,consolidation usually occurred in one side and upper lung,nodules were more common in one side,and voids and crescent signs were more common in upper lung.The detection rate of CT on pulmonary tuberculosis complicated with pulmonary aspergillus infection was 86.84%(66/76),the detection rate of sputum culture was 75.00%(57/76),and the detection rate of pathological examination was 100.00%(76/76).All 76 patients were given anti-TB treatment,of whom 12 patients underwent surgical resection of lesions,17 patients underwent bronchoscopy interventional therapy and were all given antimicrobial therapy after surgery,34 patients underwent bronchoscopy antimicrobial therapy,and 13 patients were given antimicrobial therapy.All patients were revisited after 3 months of treatment.During the follow-up,only 2 patients who were treated with antimicrobial drugs only had aggravated conditions,others did not have recurrence of aspergillus infection or exacerbation.Conclusions There are many susceptible factors for pulmonary tuberculosis complicated with pulmonary aspergillus infection.The clinical manifestations are mostly presented by hemoptysis,cough and expectoration,and other symptoms.The imaging features and clinical manifestations are not typical,pathological examination is the gold standard in the diagnosis of this disease.Clinical treatment of this disease should be based on the patients'own needs and condition to formulate a reasonable treatment plan.