老年COPD合并侵袭性肺曲霉菌病的临床特点及伏立康唑与胸腺肽a1联合干预效果分析  

Analysis of the clinical characteristics of elderly patients with COPD complicated with invasive pulmonary aspergillosis and the combined intervention effects of voriconazole and thymosin a1

作　　者：易涛平[1] 兰四友 陈波[1] 

机构地区：[1]隆昌县人民医院呼吸二科,内江642150 [2]四川医科大学附属第一医院呼吸一科,泸州646000

出　　处：《国际呼吸杂志》2016年第6期427-430,共4页International Journal of Respiration

摘　　要：目的分析老年COPD并侵袭性肺曲霉菌病（invasivepulmonaryaspergillosis，IPA）的临床特点及伏立康唑、胸腺肽“。干预效果。方法回顾性分析我院2010年3月至2015年2月收治的46例老年COPD合并IPA患者的临床资料，分析其临床特点及治疗转归。结果①老年COPD并IPA患者以呼吸困难、咳嗽、咳痰为特点，常全身应用类固醇激素、抗生素，胸部x线以斑片状渗出为特点，其次为胸腔积液、结节；CT以渗出为特点，其次为胸腔积液、结节、晕轮征。②治疗后，2组免疫细胞水平均有明显改善，以联合组各项改善更明显，分别为（37．62±4．38）％、1．81±0．49、（18．94±6．09）ng／L、（133．63±30．37）ng／L，与常规组治疗后对比差异均有统计学意义（t=5．946、3．262、4．896、2．071，P〈0．05）；③联合组临床治愈率（62．50％）高于常规组（31．82％），对比差异有统计学意义（x2=4．330，P〈0．05），虽其随访生存率（79．17％）高于常规组（54．55％），但对比差异无统计学意义（P〉0．05）；④常规组人工气道保留时间为（20．12±5．41）d，长于联合组的（13．74±4．21）d（t=4．484，P〈0．05）。结论老年COPD并IPA患者以呼吸困难、咳嗽、咳痰为特点，广谱应用抗生素、类固醇激素为其危险因素，影像学以渗出、结节、胸腔积液为特点，采用伏立康唑、胸腺肽a。联用可改善患者肺部症状，提升机体免疫功能。Objective To analyze the clinical characteristics of elderly patients with chronic obstructive pulmonary disease （COPD） complicated with invasive pulmonary aspergillosis （IPA） and the intervention effects of voriconazole and thymosin al . Methods The clinical data of 46 cases of elderly patients with COPD complicated with IPA who were treated in our hospital between March 2010 and February 2015 were retrospectively analyzed. The clinical characteristics and treatment outcomes were analyzed. Results （1）Elderly patients with COPD complicated with IPA were characterized by dyspnea, cough and expectoration, and often systemically use steroid hormones and antibiotics. Chest X-ray was characterized by patchy exudation, followed by pleural effusion and nodules; CT was characterized by exudation, followed by pleural effusion, nodules and halo signs; （2） After treatment, the levels of immune cells in the 2 groups were significantly improved and the improvement in the combined group was more significant, which were （37. 62±4. 38）% , （1.81±0.49）, （18.94±6.09） ng/L and （133.63±30.37） ng/ L respectively; Compared with those in the routine group after treatment, there were statistically significant differences （ t = 5. 946, 3. 262, 4. 896, 2. 071, P 〈 0.05） ; （ The clinical cure rate in the combined group （62.50 % ） was higher than that in the routine group （ 31.82 % ） （ x2 = 4. 330, P 〈0. 05）.Although the survival rate （79.17 % ） was higher than that in the routine group （54.55 % ）, the difference was not statistically significant （ P 〉0.05） ; The retention time of artificial airway of the routine group （20.12±5.41） d was longer than that of the combined group [-（13.74±4.21） d2 （ t =4. 484, P 〈0.05）. Conclusions Elderly patients COPD complicated with IPA are characterized by dyspnea, cough and expectoration. Broad spectrum application of antibiotics and steroid hormones is the risk factor. Imaging is characterized by exudation, nodules and

关 键 词：肺疾病 慢性阻塞性 侵袭性肺曲霉菌病 伏立康唑 胸腺肽Α1 特点 

分 类 号：R563.9[医药卫生—呼吸系统] R519[医药卫生—内科学]