13例侵袭性肺曲霉菌病继发机化性肺炎的临床特征分析

Clinical characteristics of 13 cases of organizing pneumonia secondaryto invasive pulmonary aspergillosis

目的 分析侵袭性肺曲霉菌病继发机化性肺炎的临床特点。方法 收集郑州大学第一附属医院呼吸内科2019年1月至2021年1月经病理确诊的13例侵袭性肺曲霉菌病继发机化性肺炎患者的临床资料,回顾性分析患者的临床特征、实验室检查、影像特征、治疗及转归。结果 大部分患者在侵袭性肺曲霉菌病确诊2~3周发病,均有咳嗽、咳痰、发热,伴C反应蛋白和红细胞沉降率升高;胸部CT显示为原感染灶周围出现斑片状阴影,多伴实变、晕征、支气管充气征,可伴空洞、胸腔积液;继发双肺多叶段受累,多为小斑片状阴影、结节影、树芽征;接受糖皮质激素治疗后,1周内症状均得到控制,疗程3~6个月。结论 侵袭性肺曲霉菌病继发机化性肺炎的临床特征与隐源性机化性肺炎有一定相似性,预后更好。

Objective To analyze the clinical characteristics of organizing pneumonia secondary to invasive pulmonary aspergillosis.Methods A total of 13 patients with organizing pneumonia secondary to invasive pulmonary aspergillosis in the Department of Respiratory,the First Affiliated Hospital of Zhengzhou University diagnosed by pathology from January 2019 to January 2021 were retrospectively included,and their clinical characteristics,laboratory examination,imaging characteristics,treatment and prognosis were comprehensively analyzed.Results Most cases of pulmonary aspergillosis occurred within 2-3 weeks of diagnosis,with coughing,expectoration,fever,and elevated C-reactive protein and erythrocyte sedimentation rate.Chest computed tomography showed patchy shadows around the original infection focus,mostly accompanied by consolidation,halo sign,bronchial inflation sign,and might be accompanied by cavity and pleural effusion;secondary multi lobed involvement of both lungs was observed,mostly with small patchy shadows,nodular shadows,and tree bud signs.After receiving glucocorticoid treatment,the symptoms were controlled within one week,and the glucocorticoid treatment course was mostly 3-6 months.Conclusion The clinical characteristics of organizing pneumonia secondary to invasive pulmonary aspergillosis are somewhat similar to those of cryptogenic organizing pneumonia and have a better prognosis.