粒细胞缺乏与非粒细胞缺乏患者侵袭性肺曲霉菌病的临床特点对比分析  

Clinical characteristics of invasive pulmonary aspergillosis in neutropenic and non-neutropenic patients:a comparative study

作　　者：金儿[1] 马若冰[1] 李婧[1] 祁明浩[1] 王利民[1] 任振义[1] 

机构地区：[1]杭州市第一人民医院呼吸内科,浙江杭州310006

出　　处：《中华医院感染学杂志》2012年第23期5246-5248,共3页Chinese Journal of Nosocomiology

摘　　要：目的对比分析侵袭性肺曲霉菌病(IPA)粒细胞缺乏组和非粒细胞缺乏组患者的临床特点,为其早期诊断与治疗提供理论依据。方法对医院2008年5月-2011年10月58例侵袭性肺曲霉菌病患者按粒细胞计数分为粒细胞缺乏组和非粒细胞缺乏组,对其临床特点进行回顾性对比分析。结果粒细胞缺乏组确诊率为7.7%,低于非粒细胞缺乏组的47.4%;粒细胞缺乏组临床表现以抗菌药物无效的长期发热为主,发生率为74.4%,而非粒细胞缺乏组以咯血为主,发生率为63.2%;粒细胞缺乏痰培养的阳性率为30.8%,低于非粒细胞缺乏为52.6%,粒细胞缺乏组肺部CT多见两肺多发结节、晕征,发生率分别为79.5%、51.3%,非粒细胞缺乏组以团块影为主,发生率为47.4%;粒细胞缺乏组使用抗真菌药总体有效率为38.5%,低于非粒细胞缺乏组的57.9%,前者死亡率为61.5%,高于后者的42.1%。结论 IPA粒细胞缺乏与非粒细胞缺乏组临床特点不同,认识这些特点对早期诊断和治疗有重要价值。OBJECTIVE To compare the clinical characteristics of invasive pulmonary aspergillosis （IPA） between the neutropenic and non-neutropenic patients so as to provide the orotical basis for the cliagnosis and treatment in the early stage, METHODS A total of 58 patients with IPA who enrolled hospital from May 2008 to Oct 2011 were divided into the neutropenic group and the non--neutropenic group based on the neutrophils counts, the clinical char^cteristlcs were retrospectively analyzed. RESULTS The diagnosis rate of the neutropenic group was 7.7%, lower than 47.4% of the non-neutropenic group; the neutropenic group characterized by antibiotic resistant fever （74, 4%）, while haemoptysis（63, 2%） was an initial symptom in the non-neutropenic group; the susceptibility of the sputum culture of the neutropenic group was 30.8%, lower than 52.6% of the non-neutropenic group. The lung CT showed that the multiple nodules and halo sign in both of the lungs were the typical manifestations of the neutropenic group, the incidence rates were 79.5 % and 51.3 % respectively, and the mass lesion shadow was the main manifestation of the non-neutropenic group with the incidence of 47. 4% the total effective rate of the antifungal agents was 38. 5% in the neutropenic group, lower than 57. 9% of the non-nneutropenie group, the mortality rate of the former was 61. 5%, the latter 42. 1%. CONCLUSION The clinical characteristics of the neutropeniagroup are different with those of the non-neutropenic group, it is of great significance in the early diagnosis and treatment to grasp these characteristics.

关 键 词：曲霉菌病 肺部 临床分析 

分 类 号：R181.32[医药卫生—流行病学]