非粒细胞缺乏侵袭性气管支气管曲霉病发生的危险因素及预后分析

Risk factors and prognosis of invasive tracheobronchial aspergillosis in non-neutropenic patients

目的探讨在非粒细胞缺乏侵袭性肺曲霉病(IPA)患者中,发生侵袭性气管支气管曲霉病(ITBA)的危险因素及预后。方法根据2008年版欧洲癌症研究治疗组织(EORTC)和真菌研究组(MSG)制定的EORTC/MSG标准,将2015年5月—2021年4月在郑州大学第一附属医院诊断为非粒细胞缺乏IPA的患者分为ITBA组和气道正常组,并进行回顾性分析。结果共48例非粒细胞缺乏IPA患者,ITBA组23例,气道正常组25例。咳嗽、发热、胸闷是常见的症状。两组相比较,ITBA组患者喘息症状比气道正常组突出,常见影像学表现为沿支气管分布的双肺多发结节影、斑片状浸润影,经常吸烟、合并2型糖尿病比例高于气道正常组,差异具有统计学意义(P<0.05)。23例ITBA组患者中死亡4例,生存19例。ITBA组的死亡率高于气道正常组(17.39%对12.00%),但差异无统计学意义(P>0.05)。死亡亚组患者中性粒细胞计数、机械通气比例高于生存亚组,血红蛋白水平低于生存亚组,差异有统计学意义(P<0.05)。结论经常吸烟及2型糖尿病是非粒细胞缺乏患者发生ITBA的危险因素,ITBA并不增加非粒细胞缺乏IPA患者的死亡率,但中性粒细胞计数较高、血红蛋白水平较低、机械通气是非粒细胞缺乏ITBA患者死亡的危险因素。

Objective To investigate the risk factors and prognosis of invasive tracheobronchial aspergillosis(ITBA)in non-neutropenic patients with invasive pulmonary aspergillosis(IPA).Methods According to the definitions of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group in 2008,the patients diagnosed as non-neutropenic IPA in the First Affiliated Hospital of Zhengzhou University from May 2015 to April 2021 were assigned to ITBA group or normal airway control group.Results IPA was confirmed in 48 non-neutropenic patients,including 23 patients in ITBA group and 25 patients in normal airway group.Cough,fever,chest tightness were the common symptoms.The wheezing symptoms were more prominent in ITBA group than in the normal airway group.The common imaging features were multiple nodular opacities and patchy infiltrative opacities along the bronchi in both lungs.ITBA patients were associated with significantly higher proportion of smokers and type 2 diabetics than the normal airway controls(P<0.05).ITBA group showed higher mortality rate than normal airway controls(17.39%vs.12.00%,P>0.05).Overall,4 of the 23 ITBA patients died,and 19 survived.The death subgroup was associated with higher neutrophils and mechanical ventilation and lower hemoglobin compared to survivor subgroup(P<0.05).Conclusions Smoking and type 2 diabetes are risk factors for ITBA in non-neutropenic patients.ITBA does not increase mortality in patients with non-neutropenic IPA,but high neutrophil count,low hemoglobin level,and mechanical ventilation are risk factors for death in patients with non-neutropenic ITBA.