无基础病的原发侵袭性肺曲霉病19例临床诊治分析  

Clinical diagnosis and treatment of 19 cases of primary invasive pulmonary aspergillosis without underlying diseases

作　　者：覃华姣 邓静敏[1] 张建全[1] 何志义[1] 白晶[1] 杨美玲[1] 韦旋[1] 梁斯巧[1] Qin Huajiao;Deng Jingmin;Zhang Jianquan;He Zhiyi;Bai Jing;Yang Meiling;Wei Xuan;Liang Siqiao(Department of Respiratory Medicine,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院呼吸与危重症医学科

出　　处：《中华临床医师杂志（电子版）》2019年第7期504-509,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的通过收集病例资料并进行总结分析以加强临床医师对原发性侵袭性肺曲霉病(IPA)的认识。方法回顾性分析2012年1月至2018年9月在广西医科大学第一附属医院诊断IPA患者的临床资料。结果19例患者中,男性6例,女性13例,平均年龄(42±14)岁;主要症状为咯血(84.2%,16/19)、咳嗽(73.7%,14/19)、咳痰(63.2%,12/19)、呼吸困难(10.5%,2/19)、胸痛(31.6%,6/19)、发热(21.1%,4/19),仅1例(5.3%,1/19)可闻及肺部啰音。实验室检查主要发现白细胞计数升高(15.8%,3/19)、C反应蛋白浓度升高(53.8%,7/13)、半乳甘露聚糖(GM)抗原检测试验阳性(60.0%,3/5)。接受肺功能检查14例:4例通气功能障碍并弥散功能障碍。接受支气管镜检查10例:8例黏膜充血,4例镜下出血,9例异常分泌物。胸部影像学主要表现为空洞(47.4%,9/19)、结节(52.6%,10/19)、实变(78.9%,15/19)、空气新月征(31.6%,6/19)。11例曾被误诊为肺结核、肺炎、炎性假瘤。结论原发性IPA可发生在无基础病的群体,极易误诊,当患者出现咳嗽、咳痰、咯血、GM抗原检测试验阳性,CT表现为结节、空洞、空气新月征,且抗细菌治疗无效时,应警惕此病的发生。Objective To improve clinicians’understanding of primary invasive pulmonary aspergillosis(IPA)by collecting and analyzing the data of cases diagnosed at our hospital.Methods A retrospective study was performed to analyze all cases of IPA patients who were diagnosed at the First Affiliated Hospital of Guangxi Medical University from January 2012 to September 2018.Results Among the 19 patients,6 were male and 13 were female,with an average age of(42±14)years.The main symptoms included hemoptysis(84.2%,16/19),cough(73.7%,14/19),sputum production(63.2%,12/19),dyspnea(10.5%,2/19),chest pain(31.6%,6/19),and fever(21.1%,4/19).The wheezing sound was heard in only 1(5.3%,1/19)case.Laboratory examinations mainly revealed increased white blood cells(15.8%,3/19),increased C-reactive protein(53.8%,7/13),and positive galactomannan(GM)test(60.0%,3/5).Of 14 cases who underwent pulmonary function assessments,4 had ventilation dysfunction and dispersion dysfunction.Of 10 cases who underwent bronchoscopic examination,mucosal hyperemia was found in 8 cases,hemorrhage in 4,and abnormal airway secretions in 9.The main manifestations of chest imaging included cavities(47.4%,9/19),nodules(52.6%,10/19),consolidation(78.9%,15/19),and air crescent(31.6%,6/19).Eleven cases were misdiagnosed as tuberculosis,pneumonia,or inflammatory pseudotumor.Conclusion Primary IPA can occur in people without underlying disease,which is easily misdiagnosed.When a patient has cough,sputum,hemoptysis,and positive GM test,as well as CT manifestations of nodules,cavities,and air crescent,and when antibacterial treatment is ineffective,primary IPA should be considered.

关 键 词：原发性 侵袭性肺曲霉病 诊断 治疗 

分 类 号：R73[医药卫生—肿瘤]