无免疫缺陷者侵袭性气道肺曲霉病的支气管镜和胸部CT表现  

Bronchoscopic and CT findings of invasive tracheobronchial and pulmonary aspergillosis in patients without immunodeficiency

作　　者：李玉苹[1] 陈咸水[1] 叶民[1] 叶君如[1] 周颖[1] 吴秀玲[2] 

机构地区：[1]温州医学院附属第一医院呼吸科,325000 [2]温州医学院附属第一医院病理科,325000

出　　处：《中华结核和呼吸杂志》2009年第6期439-443,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨无免疫缺陷者侵袭性气道肺曲霉病的支气管镜表现和胸部CT特点。方法回顾性分析2004年1月至2008年8月温州医学院附属第一医院呼吸科收住的6例无免疫缺陷者并发侵袭性气道肺曲霉病的临床资料，复习文献探讨其支气管镜表现和胸部CT特点。结果6例患者经仔细检查均未发现免疫抑制的基础疾病。支气管镜检查结果均符合侵袭性气道曲霉病，镜下表现以肿块、溃疡坏死或伪膜性气管支气管炎为主。胸部CT早期表现为双肺纹理增粗；病情进展后表现为局灶实变，结节、多个空洞，紧邻支气管分布；也可表现为单个结节。所有患者在行支气管镜检查前均被误诊，曾反复使用抗生素和糖皮质激素。结论无免疫缺陷者侵袭性气道肺曲霉病的支气管镜表现以溃疡坏死、伪膜性气管支气管炎和气道内肿块为主；胸部CT可见沿支气管分布的渗出实变影，以结节和多个空洞为主；也可表现为单个结节。Objective To explore the bronchoscopic and CT findings of invasive tracheobronchial and pulmonary aspergillosis in patients without immunodeficiency. Methods Clinical data and bronchoscopic and CT findings of 6 patients with tracheobronchial and pulmonary aspergillosis were reviewed from January 2004 to August 2008. Results All the patients had no immunodificiency diseases. The bronchoscopic findings mostly presented in 2 forms： single endobronchial nodule and ulcerative or pseudomembranous tracheobronehitis. The lesions were diffusely distributed or localized. Chest CT showed tracheal or bronchial wall thickening in the early stage, and with disease progression, local consolidation or multiple nodules and cavitation became the most common findings. The nodules and cavities were predominantly peribronchial. A solitary nodule was found in 2 patients. All the cases had been misdiagnosed as other diseases, and repeated courses of antibiotics or corticosteroids had been tried. Conclusions Ulcerative or pseudomembranons tracheobronchitis and single nodule are the most common bronchoscopic fingdings of invasive tracheobronchial aspergillosis. Local consolidation, multiple nodules and cavitation with predominantly peribroncbial distribution are the most common CT fingdings.

关 键 词：曲霉菌病 支气管镜检查 体层摄影术 X线计算机 

分 类 号：R686[医药卫生—骨科学]