结缔组织病合并侵袭性肺曲霉菌病20例临床分析  

Invasive pulmanory aspergillosis with connective tissue diseases:an analysis of 20 cases

作　　者：张立民[1] 蒋颖[1] 曾小峰[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,100730

出　　处：《北京医学》2010年第3期194-196,共3页Beijing Medical Journal

基　　金：国家科技支撑计划基金(2008BAI59B02)

摘　　要：目的探讨结缔组织病合并侵袭性肺曲霉菌病的易患因素、临床特征、治疗方法及预后。方法回顾性分析北京协和医院1995～2009年结缔组织病合并侵袭性肺曲霉菌病患者的临床资料。结果共检索肺曲霉菌病患者96例,合并结缔组织病患者20例。其中系统性红斑狼疮10例,抗中性粒细胞胞浆抗体(ANCA)相关性血管炎5例,炎性肌病5例。长期使用糖皮质激素14例,长期使用免疫抑制剂10例,长期使用广谱抗生素10例,低蛋白血症11例。临床症状无特异性。CT显示斑片浸润影12例,结节影10例,空洞形成4例。痰培养阳性19例,支气管灌洗液培养3例,纤支镜活检病理2例,经皮肺穿活检病理2例。初始治疗:给予二性霉素B7例,依曲康唑6例,伏立康唑7例。治愈5例,好转2例,未愈2例,死亡11例(55%)。结论结缔组织病合并侵袭性肺曲霉菌感染病死率髙,长期应用糖皮质激素、免疫抑制剂、广谱抗生素及低蛋白血症为结缔组织病并发侵袭性肺曲霉菌病的风险因素。及时进行反复痰培养、开展有创检查,如纤支镜下肺泡灌洗、肺活检有助早期诊断,改善预后。Objective To investigate the major predisposing factor,clinical features,diagnosis,antifungal therapy and prognosis of invasive pulmonary aspergillosis （IPA） in patients with connective tissue disease （CTD）.Methods 20 cases of IPA with CTD patients admitted in the PUMC hospital from 1995 to 2009 were reviewed.Results 20 cases of IPA with CTD patients included 10 cases of systemic lupus erythematosus,5 cases of ANCA-associated vasculitides and 5 cases of inflammatory myopathies.The predisposing factor for IPA included prolonged use of steroid （14 cases）,immunosuppressant（10 cases）,broad spectrum antibiotics（10 cases） and hypoalbuminemia（11 cases）.All the clinical manifestations of IPA with CTD were not specific.Chest CT scan findings included infiltrates（12 cases）,multiple nodules（10 cases）,and cavity（4 cases）.The sputum culture was positive in 19 patients,bronchoalveolar lavage fluid was positive in 3 patient,and bronchoscope/lung biopsy was positive in 4 patients.First line antifungal therapy included amphotericin B （7 cases）,itraconazole （6 cases）,or voriconazole （7 cases）.The overall mortality was 55%（11/20）.Conclusions The mortality of aspergillus infection with CTD is high.Prolonged use of steroid,immunosuppressant,broad spectrum antibiotics and hypoalbuminemia are risk factors of CTD patients complicated with IPA.It is helpful for diagnosis to make sputum culture and to carry out invasive examinations promptly such as bronchoalveolar lavage and lung biopsy.

关 键 词：结缔组织病 侵袭性肺曲霉菌病 临床分析 

分 类 号：R519[医药卫生—内科学] R593.2[医药卫生—临床医学]