肺恶性肿瘤病变并存真菌感染患者的临床特点分析

Analysis of clinical characteristics of patients with malignant lung tumors complicated with fungal infections

目的探讨肺恶性肿瘤病变并存真菌感染的临床特点、炎症指标、胸部计算机断层扫描(CT)表现、病理学特点及治疗转归。方法回顾性分析2012年3月至2019年5月在郑州大学第一附属医院就诊的肺组织病理符合同部位肺恶性肿瘤病变并存真菌感染患者的临床资料。结果肺恶性肿瘤病变并存真菌感染患者32例,其中男24例、女8例,中位年龄63岁。肺原发恶性肿瘤病变并存真菌感染30例和肺转移性恶性肿瘤病变并存曲霉菌感染2例。肺恶性肿瘤病变并存真菌感染患者的主要临床表现为咳嗽(27例)和咳痰(24例)、咯血(16例)、胸闷(14例)、发热(10例)。CT示气管型肺癌1例、中央型肺癌24例和周围型肺癌7例和。5例血清1-3-β-D葡聚糖水平增高和6例血清曲霉半乳甘露聚糖水平增高。6例早期肺原发性恶性肿瘤予以围手术期短疗程抗真菌治疗联合胸腔镜根治术;26例晚期肺恶性肿瘤患者予以短疗程为主抗真菌治疗后化疗,但1例化疗后和1例放疗后复诊时明确肺鳞癌病变并存曲霉菌感染者在初始伏立康唑治疗期间,病情仍迅速恶化为重型侵袭性肺曲霉菌病,最终死亡。6例胸腔镜根治术后患者病情无复发;24例晚期肺恶性肿瘤患者后续无抗真菌治疗,平均化疗10个周期,病灶无进展且病情稳定。结论肺恶性肿瘤病变并存真菌感染患者尤以曲霉菌感染最为常见,CT示以中央型肺癌为主,大多数患者血清1-3-β-D葡聚糖和曲霉半乳甘露聚糖水平不高;对于初诊肺恶性肿瘤病变并存曲霉菌感染无化疗或放疗史者,短疗程抗真菌治疗后可谨慎开始化疗。但化疗或放疗后肺恶性肿瘤病变并存真菌感染者病情可迅速进展,需早期联合或升级抗真菌治疗以改善预后。

Objective To study the clinical characteristics,inflammatory indicators,chest computed tomography(CT)manifestations,fiberoptic bronchoscopy findings,pathological features,and treatment outcomes of malignant lung tumors complicated with fungal infections.Methods A retrospective study was conducted on clinical data from patients with malignant lung tumors complicated with fungal infections confirmed by histopathology carried out at the same sitein the First Affiliated Hospital of Zhengzhou University from March 2012 to May 2019.Results Thirty-two cases of malignant lung tumors complicated with fungal infections were identified,included 24 males and 8 females,with a median age of 63 years.There were 30 cases of primary malignant lung tumors with fungal infections and 2 cases of metastatic malignant lung tumors complicated with aspergillosis.The main symptoms were cough(27 cases),expectoration(24 cases),hemoptysis(16 cases),chest tightness(14 cases)and fever(10 cases).CT images revealed 24 cases of central lung cancer,7 cases of peripheral lung cancer and 1 case of tracheal lung cancer.The serum 1-3-β-D glucan levels were elevated in 5 cases,and the galactomannan levels were elevated in 6 cases.Six patients with early primary lung cancer received perioperative short-term anti-fungal therapy and radical thoracoscopic surgery.Twenty-six patients with advanced lung cancer were treated by an initial short course of anti-fungal therapy before chemotherapy,however,during the treatment with voriconazole,two repeat patients with lung squamous cell carcinoma and aspergillosis after chemotherapy or radiotherapy rapidly deteriorated into severe invasive pulmonary aspergillosis,which eventually led to death.Six patients who received radical thoracoscopic surgery experienced no relapse;24 patients with advanced malignant lung tumors received no anti-fungal therapy in the follow-up time and underwent an average of ten cycles of chemotherapy.All the 24 patients were stable and not progressive.Conclusion Malignant lung tumors complicated with fungal infections was dominated by aspergillosis in the patients included in this study.CT imaging primarily identified central lung cancer.The serum levels of 1-3-β-D glucan and galactomannan were not elevated in most of patients.Therefore,newly diagnosed patients with malignant lung tumors complicated with fungal infections and no history of chemotherapy or radiotherapy could cautiously receive chemotherapy after a short course of anti-fungal therapy.However,fungal infections in repeat patients could progress rapidly after chemotherapy or radiotherapy,so early treatment combinations or advanced anti-fungal therapy are needed to improve the prognosis.