免疫缺陷患者侵袭性肺曲霉病的临床分析

Clinical analysis of invasive pulmonary aspergillosis in immunodeficient patients

目的总结免疫缺陷患者侵袭性肺曲霉病(IPA)的临床特征,加深临床医师对IPA的认识。方法回顾性分析2015年1月—2019年3月在浙江大学医学院附属第一医院住院的101例IPA患者的临床资料。将患者分为粒细胞缺乏组、实体器官移植组、慢性阻塞性肺疾病组、结缔组织病组、慢性肾病组。比较各组的临床特点和影像学特征。结果粒细胞缺乏组有发热症状的患者比例多于慢性阻塞性肺疾病组,慢性阻塞性肺疾病组中咯痰、气促的患者比例多于其他各组。CT影像晕征在粒细胞缺乏组多见。结论免疫缺陷患者侵袭性肺曲霉感染的临床特征与基础疾病相关,影像学特点表现为结节团块影及晕征,但在慢性阻塞性肺疾病中不典型。

Objective To summarize the clinical features of invasive pulmonary aspergillosis(IPA)in immunodeficient patients and to deepen the understanding of IPA among clinicians.Methods The clinical data of 101 IPA patients who were hospitalized in the First Affiliated Hospital,School of Medicine,Zhejiang University from January 2015 to March 2019 were retrospectively analyzed.The patients were assigned to different groups based on the presence of neutropenia,solid organ transplantation,chronic obstructive pulmonary disease(COPD),connective tissue disease,or chronic kidney disease.The clinical and imaging characteristics were compared between patient groups.Results Higher proportion of neutropenic patients had fever than the COPD patients.Higher proportion of COPD patients had cough and shortness of breath than other patients.Cavity lesions were more common in the patients with COPD or chronic kidney disease.Halo sign was more common in the neutropenic patients.Conclusions The clinical features of IPA are related to the underlying diseases in immunodeficiency patients.Nodular mass and halo sign are primary imaging features of IPA,but atypical in COPD patients.