慢性阻塞性肺疾病合并侵袭性肺曲霉菌病感染的临床特点  

Clinical features of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

作　　者：来孺牛[1] 金国萍[2] 王亚南[2] 周建明[3] 

机构地区：[1]浙江省绍兴市人民医院(浙江大学绍兴医院)呼吸内科,312000 [2]浙江省绍兴市人民医院(浙江大学绍兴医院)重症监护室,312000 [3]浙江大学公共卫生学院预防医学系,310000

出　　处：《中华全科医学》2015年第2期181-183,共3页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2009FWG075)

摘　　要：目的探讨慢性阻塞性肺疾病合并侵袭性肺曲霉菌病感染的临床特点,为预防和控制提供参考依据。方法采用回顾性与前瞻性相结合的调查方法对绍兴市人民医院2009年1月—2012年12月收治的19例COPD合并IPA患者的临床特点进行分析,探讨其临床感染特点并研究其危险因素。结果 19例COPD合并IPA患者中有15例确诊,15例临床诊断,4例拟诊。肺穿刺活检出11株曲霉菌,4株烟曲霉菌。COPD合并IPA患者临床表现无特异性,多以呼吸困难、胸闷憋气、咳嗽、食欲减退、乏力和肺部啰音为主,发热、咯血为主。而CT检查发现无特异性,发现14例为慢性支气管炎、肺气肿基础上的炎性渗出影,13例表现为晕轮征,9例患者出现双肺纹理粗乱,3例表现为段叶实变影,9例表现为结节影,2例空气新月征。COPD患者继发IPA危险因素很多,其中主要的危险因素在于大量应用广谱抗菌药物和糖皮质激素,除此之外,COPD患者发生低蛋白血症以及应用侵入性留置管均可增加IPA的风险。结论可将COPD纳入IPA的危险因素之一,对于COPD患者要特别重视其早期的临床变化及特点,反复检查其气道分泌物,反复采用CT检查对COPD继发IPA的早期诊治有积极作用,而且对于在临床上高度可疑患者不需等待影像学或培养的结果,而应快速开始预防性治疗。Objective To study the clinical features of invasive pulmonary aspergillosis（ IPA） in patients with chronic obstructive pulmonary disease（ COPD）,and provide reference for the prevention and control. Methods A combined retrospective and prospective study was performed in our hospital from January,2009 to December,2012 to analyze the clinical features of IPA in 19 patients with COPD,the infectious characteristics and related risk factors were studied. Results Fifteen of 19 patients were confirmed clinically,4 were suspected. The percutancous lung biopsy tested Aspergillus in 11 cases,Aspergillus fumigatus in 4 cases. The clinical manifestations of COPD patients with IPA had no specificity,mainly included difficulty in breathing,chest tightness and shortness of breath,cough,loss of appetite,fatigue,pulmonary rales,fever and hemoptysis. CT showed that 14 cases with the inflammatory exudation shadow based on chronic bronchitis or emphysema,13 cases with halo sign,9 cases with lung texture thick chaos,3 cases with consolidation in some lung lobe and segment,9 cases with nodules,2 cases with air crescent sign. The main risk factors for COPD secondary to IPA included the widely use of broad-spectrum antibiotics and corticosteroids,hypoproteinemia,and indwelling invasive catheter. Conclusion COPD can be incorporated into one of the risk factors of IPA. For COPD patients,we should pay special attentions to the early clinical characteristics and changes,check the airway secretions. The repeated CT examination will be helpful to the early diagnosis and treatment of COPD secondary to IPA. For the clinical suspected patients,the preventive therapy should be begun immediately before the imaging or culture results completed.

关 键 词：COPD继发IPA 临床特点 危险因素 

分 类 号：R563[医药卫生—呼吸系统]