2型糖尿病合并侵袭性肺曲霉病10例临床分析

Clinical Analysis of 10 Cases of Type 2 Diabetes Mellitus Complicated with Invasive Pulmonary Aspergillosis

目的分析2型糖尿病合并侵袭性肺曲霉病(IPA)的临床特点。方法回顾性分析2015年5月至2020年3月郑州大学第一附属医院收治的10例2型糖尿病合并IPA患者的临床症状、实验室检验指标、胸部计算机体层成像(CT)、支气管镜下表现、治疗及预后。结果10例患者中男4例,女6例,确诊9例,临床诊断1例。临床症状表现为咳嗽10例、咳黄痰4例、咳灰黄色痰1例、胸闷6例、发热5例、胸痛2例、痰中带血1例。痰培养阳性率为20.00%(2/10),支气管肺泡灌洗液(BALF)培养阳性率为42.86%(3/7),共检出4例曲霉菌感染。血清半乳甘露聚糖(GM)试验阳性1例(10.00%),血清(1,3)-β-D-葡聚糖(G)试验阳性2例(20.00%)。3例患者接受BALF GM试验,均为阴性。胸部CT表现为双肺多发支气管周围渗出影4例、小结节影2例,可融合为结节状或片状实变影,边界模糊,密度不均,伴空洞形成;3例表现为单发厚壁空洞,空洞内有线样分隔影;1例表现为大片实变影。8例患者经支气管镜检查,镜下均显示双肺多段支气管管腔受累,5例管腔附着白色坏死物,3例部分管腔狭窄,2例管腔阻塞,另可见白色伪膜形成1例、黏膜充血肥厚2例、管腔内大量脓性分泌物3例。全身用抗真菌药物联合局部支气管镜下治疗后,6例好转,3例病情进展,1例病情稳定。结论2型糖尿病合并IPA的临床症状缺乏特异性,胸部CT以双肺多发支气管周围渗出、小结节影、空洞形成为主,尽早开展支气管镜检查对其诊治至关重要。

Objective To analyze the clinical characteristics of type 2 diabetes mellitus complicated with invasive pulmonary aspergillosis(IPA).Methods The clinical symptoms,laboratory test indexes,chest computed tomography(CT),bronchoscopy manifestations,treatment and prognosis of 10 patients with type 2 diabetes mellitus and IPA admitted to the First Affiliated Hospital of Zhengzhou University from May 2015 to March 2020 were retrospectively analyzed.Results Among the 10 patients,4 were male and 6 were female.Nine cases were proven and one was probable.The clinical symptoms included 10 cases of cough,4 cases of yellow sputum,1 case of gray-yellow sputum,6 cases of chest tightness,5 cases of fever,2 cases of chest pain,and 1 case of blood in sputum.The positive rate of sputum culture was 20.00%(2/10),and the positive rate of bronchoalveolar lavage fluid(BALF)culture was 42.86%(3/7).Four cases of Aspergillus infection were detected.One case(10.00%)was positive in serum galactomannan(GM)test,and two cases(20.00%)were positive in serum(1,3)-β-D-glucan(G)test.Three patients underwent the BALF GM test,all of which were negative.Chest CT showed bilateral multiple peribronchial exudation shadows in four cases and small nodular shadows in two cases,which could be merged into nodular or sheet-like consolidation shadows with indistinct borders,uneven density,and cavities;three cases showed single thick-walled cavity with line-like separation in the cavity;one case showed large area of consolidation.Eight patients underwent bronchoscopy,which showed bilateral multi-segment bronchial lumen involvement,five cases with white necrosis attached to the lumen,three cases of partial lumen stenosis,two cases of lumen obstruction,one case of white pseudomembrane formation,two cases of mucosal hyperemia and hypertrophy,and three cases of massive purulent secretions in the lumen.After systemic application of antifungal drugs and local treatment under bronchoscopy,six cases improved,three cases progressed,and one case was stable.Conclusion The clinical symptoms of type 2 diabetes mellitus complicated with IPA lack specificity.Chest CT is mainly characterized by bilateral multiple peribronchial exudates,small nodules and cavitation.Early bronchoscopy is essential for its diagnosis and treatment.