50例肺曲霉菌病临床特征  

Analysis of clinical features of 50 cases of pulmonary aspergillosis

作　　者：顾恒琼[1] 苏鑫[1] 许阳[2] 李玉柱[1] GU Heng-qiong;SU Xin;XU Yang;LI Yu-zhu(Hainan Hospital,PLA General Hospital,Sanya,Hainan 572000,China;不详)

机构地区：[1]解放军总医院海南医院呼吸与危重症医学科,海南三亚572000 [2]解放军总医院第一医学中心呼吸与危重症医学部,北京100039

出　　处：《中华医院感染学杂志》2022年第11期1697-1701,共5页Chinese Journal of Nosocomiology

摘　　要：目的探讨肺曲霉菌病(PA)患者的临床特征、诊断和治疗意义,提高对肺曲霉菌病的认识。方法回顾性分析解放军总医院海南医院2012年6月-2020年3月收治的50例肺曲霉菌病患者的一般情况、临床症状、实验室检查、胸部CT、支气管镜检查、组织病理、治疗及转归,分析其临床特点。结果50例患者,临床表现无特异性,无粒细胞缺乏,危险因素为低白蛋白血症、抗菌素使用、糖皮质激素,合并基础疾病为糖尿病、哮喘、慢性阻塞性肺疾病等,肺部影像学表现有双肺多发病灶、片状阴影、结节、空气新月征、空洞、晕轮征。GM试验、G试验阳性率均为54.0%;下呼吸道痰曲霉培养为主要方法,占42.0%。经治疗74.0%好转、6.0%无效,复发4.0%,16.0%失访。结论肺曲霉菌病并不少见,临床表现复杂多样,缺乏特异性,诊断上依赖于微生物培养和组织活检,通过早期影像学特点、实验室检查,气管镜肺泡灌洗、培养等进行鉴别,经气道内镜检可以提高早期确诊,部分病例需进一步活检确诊,尽早治疗提高预后。OBJECTIVE To investigate the clinical features,diagnosis and treatment of pulmonary aspergillosis(PA),and to improve the understanding of pulmonary aspergillosis.METHODS The general situation,clinical symptoms,laboratory examination,chest CT,bronchoscopy,histopathology,treatment and outcome in 50 patients with pulmonary aspergillus admitted to Hainan Hospital of PLA General Hospital from Jun.2012 to Mar.2020 were retrospective analyzed and their clinical characteristics were summarized.RESULTS Specific symptoms granulocyte deficiency were not found in the 50 patients.Risk factors for PA were low serum albumin level,antibiotic use,corticosteroids,basic diseases such as diabetes,asthma,chronic obstructive pulmonary disease,and multiple lesions,shape shadow,nodules,air crescent sign,hollow and halo sign in both lungs were found by lung imaging.The positive rates of GM test and G test were all 54.0%.Lower respiratory tract Aspergillus culture was the main method,accounting for 42.0%.After the treatment,74.0%of patients improved,6.0%unchanged,4.0%relapsed and 16.0%lost to follow-up.CONCLUSION Pulmonary aspergillosis is not uncommon,and its clinical symptoms are complex and varied,lacking of specificity.Diagnosis relies on the microbial cultures and biopsy,and early radiological characteristic,laboratory examination,bronchoscope alveolar lavage and cultivation methods were used for identification.Bronchoscopy can improve the early diagnosis in some cases,which needs to be further diagnosed by biopsy.Early treatment can improve prognosis.

关 键 词：肺曲霉菌病 临床特征 诊断 治疗 预后 

分 类 号：R563[医药卫生—呼吸系统]