慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的临床特点  

Clinical features of chronic obstructive pulmonary disease combined with invasive pulmonary paspergillosis

作　　者：曾惠清[1] 蔡雪莹[1] 陈波[1] 吕智[1] 彭丽红[1] 张雪玲[1] 

机构地区：[1]厦门大学附属中山医院呼吸科,福建厦门361004

出　　处：《中华医院感染学杂志》2011年第2期258-260,共3页Chinese Journal of Nosocomiology

摘　　要：目的探索慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌(IPA)的临床特点,为早期诊断和治疗提供依据。方法对从2005年1月-2010年3月厦门大学附属中山医院诊断的36例COPD合并IPA的临床资料进行回顾性分析。结果 36例COPD并IPA确诊3例,临床诊断26例,疑诊7例;培养烟曲霉菌24株,土曲霉菌5株,同时培养黄曲霉菌3株,毛霉菌2株;最常见危险因素是长期应用抗菌药物及糖皮质激素、侵入性留置管道及低蛋白血症;常见症状是呼吸困难、胸闷憋气、胸痛、饮食减少、乏力、肺部啰音,经抗菌药及激素治疗无效;早期气管镜改变可见支气管黏膜充血水肿糜烂;治疗有效27例,无效9例;有效的27例中早期经验性治疗22例,而无效的9例均为临床诊断或确诊后才开始抗曲霉菌属治疗,两种不同治疗方法的预后差异有统计学意义(P<0.01)。结论应重视分析COPD并IPA的早期临床特点,进行早期诊断及经验性治疗,可改善患者预后。OBJECTIVE To study the clinical features of invasive pulmonary aspergillosis（IPA） in patients with chronic obstructive pulmonary disease（COPD）.METHODS Thirty-six COPD with IPA cases from Jan 2005 to Mar 2010 in Xiamen University Zhongshan Hospital were retrospectively analyzed.RESULTS Among all 36 cases,3 cases were diagnosed,26 cases were diagnosed by clinical symptoms and 7 cases were possibly diagnosed.24 cases were cultured with paspergillus fungus,5 cases were aspergillus terreus,3 cases were aspergillus flavus and 2 cases were mold fungus.long-term application of antibiotics,corticosteroids,invasive operation and hypoproteinemia were the important causes leading to IPA.The most common symptoms were dyspnea,chest tightness,suffocation,chest pain,bad appetite,fatigue and pulmonary rales,and were resistant to antibiotics therapy.Early changes could be seen in bronchoscopy,including bronchial mucosal congestion edema and erosion;27 cases could be treated effectively by anti-fungus therapy while 9 cases ineffectively.Among the 27 effective cases,22 cases were received empirical anti-fungal therapy on early stage;while in the 9 ineffectively cases,all of them were received anti-fungal therapy when diagnosed as proven IPA or probable IPA.There was significant difference between the prognosis of these two groups（P〈0.01）.CONCLUSION Clinical feature plays a very important role in early diagnosis and treatment of IPA with COPD.The early diagnosis and empirical treatment of IPA will improve the prognosis.

关 键 词：慢性阻塞性肺疾病 曲霉菌病 临床特点 

分 类 号：R181.32[医药卫生—流行病学]