COPD合并侵袭性肺曲霉病5例并文献复习  

Five cases of chronic obstructive pulmonary disease and invasive pulmonary Aspergillosis and literature review

作　　者：李志强[1] 宋立强[2] 陈洁[2] 许欣婷[2] 王宝锋[1] 

机构地区：[1]宝鸡市中心医院呼吸内科,721000 [2]第四军医大学西京医院呼吸与危重症科,西安710032

出　　处：《国际呼吸杂志》2017年第17期1305-1309,共5页International Journal of Respiration

摘　　要：目的分析重症COPD合并侵袭性肺曲霉病（IPA）患者临床特征，提高对COPD合并IPA的认识。方法过从2015年6月至2016年3月西京医院呼吸与危重症科诊断的5例COPD合并IPA患者的资料进行回顾性分析及文献复习。结果5例COPD合并IPA患者中确诊3例，临床诊断2例。在人住RICU前5例使用广谱抗生素，4例使用大量激素。5例均表现为气道显著痉挛，4例使用无创机械通气后有2例转为有创机械通气，2例自动出院。胸部CT早期无特殊表现，病情进展出现沿支气管周围渗出病变以及实变，病变多发。支气管镜下可见气道黏膜水肿、充血、溃烂、伪膜形成，痰液黏稠。病情进展迅速，病死率高。结论COPD合并IPA容易误诊，病情进展快，病死率高，需充分认识其临床特点以提高诊断率及降低死亡风险。Objective To investigate the clinical manifestations of invasive pulmonary aspergillosis （IPA） in patients with chronic obsturctive pulmonary diease （COPD）, and raise the awareness of the disease and ensure early detection, early diagnosis and early treatment. Methods Clinical data of 5 COPD patients complicated with IPA from respiratory intensive care unit （RICU） in Xijing Hospital during June 2015 and March 2016 were retrospectively analyzed. Results There were 5 patients diagnosed as COPD with IPA, and three cases fulfilled criteria of proven IPA, 2 of probable IPA. All patients were treated with multiple broad-spectrum antibiotics and 4 patients were also treated with eortieosteroids. All patients showed severe bronchospasm and 4 of them needed noninvasive ventilation but all failed and 2 patients requierd invasive ventilation. Radiological finding were non-specific change in the early stage but multiple infiltrates or consolidation in the peribronchovascular at the progression stage. Bronchoscopy showed tracheobronchiM inflammatory and bronchial pseudomembrane in the different period. The disease had a rapid progress and high mortality. Conclusions COPD patients combined with IPA may progress rapidly and lead a high mortality. Early diagnosis and treatment based on certain clinical features may reduce the risk of death.

关 键 词：肺疾病 慢性阻塞性 肺曲霉病 侵袭性 临床特点 

分 类 号：R519[医药卫生—内科学] R563.9[医药卫生—临床医学]