合并慢性空洞性肺曲霉病的肺结核咯血患者临床特征及危险因素分析  

Clinical characteristics and risk factors for pulmonary tuberculosis hemoptysis patients complicated withchronic cavitary pulmonary aspergillosis

作　　者：王亚娇 张曼青 阮建文[1] WANG Yajiao;ZHANG Manqing;RUAN Jianwen(Infectious diseases section of Haikou pepoles Hospital,Haikou 571400,China)

机构地区：[1]海口市人民医院感染性疾病科,海口571400

出　　处：《中国真菌学杂志》2024年第1期30-34,共5页Chinese Journal of Mycology

摘　　要：目的分析合并慢性空洞性肺曲霉病(chronic cavitary pulmonary aspergillosis,CCPA)的肺结核咯血患者的临床特征,探讨相关危险因素。方法回顾性分析住院诊断为合并CCPA的肺结核咯血患者57例,同时随机选取同期住院诊断为未合并CCPA的肺结核咯血患者57例作为对照组。对比两组患者间临床特征、辅助检查、诊治及预后,通过二分类Logistic回归分析相关危险因素。结果与未合并CCPA组相比,合并CCPA组易出现大咯血,存在长期吸烟史,消瘦、气促、乏力等临床症状更明显,常伴有血红蛋白、血清白蛋白水平下降(P<0.5)。合并CCPA组肺部影像学均存残留空洞,54.38%伴有洞中球征,血GM实验、真菌培养、真菌免疫荧光染色阳性率分别为54.38%、38.59%、70.17%,经手术切除及至少6个月的抗真菌治疗后随访病情稳定。经Logistic二分类分析合并CCPA的肺结核咯血患者的危险因素有长期吸烟史、体重指数<18.5 kg/m 2、血清白蛋白<35 g/L(P<0.5)。结论存在肺部残留空洞的肺结核患者易合并CCPA,常伴有大咯血,需早期完善真菌培养、真菌免疫荧光染色、病理等诊断,及时抗真菌、手术等综合治疗,改善预后。Objective Analysis of clinical characteristics for pulmonary tuberculosis hemoptysis patients complicated with chronic cavitary pulmonary aspergillosis(CCPA)and to investigate the risk factors.Methods Retrospective analysis of 57 cases diagnosed pulmonary tuberculosis hemoptysis with CCPA patients,and 57cases diagnosed pulmonary tuberculosis hemoptysis with non-CCPA patients were randomly selected as the control group.The clinical characteristics,auxiliary examination,diagnosis and treatment and prognosis of patients in the two groups were compared.Risk factors were analyzed by binomial logistic regression.Results Compared with the non-CCPA group,the CCPA group was prone to massive hemoptysis,had a long-term smoking history,and had more obvious clinical symptoms such as emaciation,anhelation and fatigue,often accompanied by decreased hemoglobin and serum albumin levels(P<0.05).There were residual cavities in lung imaging of patients with CCPA and 54.38%had ball-in-hole sign,The positive rates of blood galactomannan antigen test,fungal culture and fungal immunofluorescence staining were 54.38%、38.59%and 70.17%,respectively.The patient's condition was stable after surgical resection and antifungal treatment for at least 6 months.Logistic binary analysis showed that the risk factors of pulmonary tuberculosis hemoptysis patients with CCPA were long-term smoking history,body mass index<18.5 kg/m 2,serum albumin<35 g/L(P<0.5).Conclusion Pulmonary tuberculosis patients with residual cavities are easy to be complicated with CCPA,often accompanied by massive hemoptysis.It is necessary to improve the diagnosis of fungal culture,fungal immunofluorescence staining,pathological diagnosis,and timely comprehensive treatment such as antifungal and surgery to improve the prognosis.

关 键 词：肺结核 咯血 慢性空洞性肺曲霉病 危险因素 

分 类 号：R519.8[医药卫生—内科学]