慢性坏死性肺曲霉病与肺曲霉球临床病理比较分析  

Comparison of clinical histopathology of chronic necrotizing pulmonary aspergillosis and aspergilloma

作　　者：郑玉龙[1] 丁伟[2] 周建英[3] 

机构地区：[1]浙江大学医学院附属第一医院化疗科,杭州310003 [2]浙江大学医学院附属第一医院病理科,杭州310003 [3]浙江大学医学院附属第一医院呼吸科,杭州310003

出　　处：《中华传染病杂志》2008年第5期305-308,共4页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金资助项目（30670930）

摘　　要：目的了解慢性坏死性肺曲霉病（CNPA）与肺曲霉球的临床表现、影像学和病理学特点。方法回顾性分析2000至2004年浙江大学附属第一医院手术和病理证实的8例CNPA和26例肺曲霉球患者的临床表现、影像学和病理资料。结果CNPA和肺曲霉球在发病年龄上差异无统计学意义，且都好发于陈旧性肺结核与肺脓肿患者。8例CNPA患者均有咳嗽、咳痰，7例咯血，5例伴全身中毒症状。26例肺曲霉球患者中，最常见的症状为咯血，有25例，咳嗽、咳痰17例，2例伴有全身中毒症状。影像学上，CNPA和肺曲霉球均可出现空气新月征，有提示性诊断意义，但前者空洞周围有浸润阴影、洞壁较厚和洞壁不规则等特征。病理学上，CNPA和肺曲霉球都可见锐角分支、有隔膜的曲霉菌丝，但前者的特点是肺组织内有曲霉菌丝侵袭、组织坏死和肉芽形成，曲霉菌只在空洞或扩张成囊的支气管内生长，不侵犯肺组织。结论组织病理检查是鉴别CNPA和肺曲霉球的金标准，临床和影像学检查也有一定价值。Objective To evaluate the role of clinical features, radiography and histopathology in differential diagnosis between chronic necrotizing pulmonary aspergillosis （CNPA） and aspergilloma. Methods Thirty-four patients including 8 cases of CNPA and 26 of aspergilloma comfirmed by operation and histopathology in First Affiliated Hospital, Zhejiang University were investigated retrospectively. The clinical manifestations, radiological and pathological findings of all the patients were analyzed and related references were reviewed. Results The age of onset was not significantly different between CNPA and aspergilloma. Obsolete pulmonary tuberculosis and lung abscess were predisposing factors of them. Productive cough was presented in all 8 cases of CNPA, haemoptysis in 7, and 5 were presented with constitutional symptoms. The most common symptom of aspergilloma was haemoptysis, which was presented in 25 cases. The less common symptoms were cough and sputum, which was presented in 17 cases. Only two cases were presented with constitutional symptoms. ＂Air crescent＂ sign at radiography was typical and suggestive of diagnosis in both CNPA and aspergilloma, but the wall of cavity in CNPA was thicker and irregular, infiltrates were often to be seen around the cavity. Histologically, CNPA and aspergilloma both showed septate fungal hyphae branching at an acute angle. CNPA was characterized with the presence of tissue invasion by aspergillus, tissue necrosis and granulomatous inflammation. Fungal hyphae were only found in a preexistent cavity or ectatic bronchus without tissue invasion in aspergilloma. Conclusions Histopathology is gold standard of differential diagnosis of CNPA and aspergilloma. Meanwhile, clinical features and radiologieal findings appear to he wduable for the diagnosis.

关 键 词：肺疾病 真菌性 曲霉菌病 诊断 鉴别 慢性病 

分 类 号：R519[医药卫生—内科学]