肺结核患者合并寄生性和侵袭性肺曲霉菌感染的临床特征分析

Analysis of the clinical features of pulmonary tuberculosis patients with parasitic or invasive pulmonary aspergillosis

目的分析肺结核患者合并寄生性和侵袭性肺曲霉菌感染的临床特征。方法回顾性分析2018—2020年长春市传染病医院收治的86例寄生性和侵袭性肺曲霉菌感染的肺结核患者资料,分析其临床症状、影像学特征及实验室检查结果。结果 86例患者中寄生性肺曲霉菌感染占70.93%,侵袭性肺曲霉菌感染占29.07%。寄生性肺曲霉菌感染患者以咯血为主,占72.13%,侵袭性肺曲霉菌感染患者以咳嗽、咯血、发热为主,分别占96.00%、92.00%、80.00%,二者咳嗽、咳痰、咯血、发热、胸痛、啰音、呼吸困难患者构成差异均有统计学意义(P<0.05);寄生性肺曲霉菌感染患者病灶形态以结节为主,边缘光滑,病灶影像主要为新月型,侵袭性肺曲霉菌感染患者病灶形态以团块为主,边缘不清晰,病灶影像主要为斑片影。寄生性肺曲霉菌和侵袭性肺曲霉菌感染者半乳甘露聚糖抗原检测阳性率分别为60.66%和84.00%,曲霉菌培养阳性率分别为55.74%和92.00%。结论肺结核患者感染寄生性肺曲霉菌和侵袭性肺曲霉菌的临床特征有明显差异,通过组织病理学及曲霉菌培养有助于临床诊断。

Objective To analyze the clinical features of pulmonary tuberculosis patients with parasitic or invasive pulmonary aspergillosis. Methods A retrospective analysis was performed on the clinical data of 86 pulmonary tuberculosis patients with parasitic or invasive pulmonary aspergillosis who were admitted to Changchun Infectious Dis-ease Hospital from 2018 to 2020. An analysis was performed on their clinical symptoms,radiological features,and laboratory examination. Results Among the 86 patients,parasitic pulmonary aspergillosis accounted for 70.93%,and invasive pulmonary aspergillosis accounted for 29.07%.Hemoptysis(72.13%) was the main symptomin patients with parasitic pulmonary aspergillosis,cough(96.00%),hemoptysis(92.00%),and fever(80.00%) were the main symptoms in patients with invasive pulmonary aspergillosis. There were significant differences in the proportions with cough,expectoration,hemoptysis,fever,chest pain,rales,and dyspnea between patients with parasitic pulmonary aspergillosis and those with invasive pulmonary aspergillosis(P <0.05). The lesions in patients with parasitic pulmonary aspergillosis were mainly nodules with smooth edges,which were mostly crescent on radiological images. The lesions in patients with invasive pulmonary aspergillosis were mainly clumps with unclear edges,which were mostly patchy on radiological images. The patients with parasitic pulmonary aspergillosis and patients with invasive pulmonary aspergillosis had positive rates for galactomannan antigen detection of 60.66% and 84.00%,respectively,and had positive rates for Aspergillus culture of 55.74% and 92.00%,respectively. Conclusion The clinical features of parasitic pulmonary aspergillosis and invasive pulmonary aspergillosis in patients with pulmonary tuberculosis have obvious specificity.Histopathology and Aspergillus culture were helpful for clinical diagnosis.