1例原发性侵袭性肺曲霉病继发大动脉炎患者的临床诊疗分析与药学监护  

Clinical Diagnosis and Treatment Analysis and Pharmaceutical Care of One Patient with Takayasu's Arteritis Secondary to Primary Invasive Pulmonary Aspergillosis

作　　者：殷茹芸 吴玥婷[2] 钱鑫[3] YIN Ru-yun;WU Yue-ting;QIAN Xin(Pharmacy Department,Qianxinan Prefecture Maternal and Child Health Hospital,Xingyi Guizhou 562400,China;Department of General Medicine,Guizhou Provincial People's Hospital,Guiyang 550002,China;Pharmacy Department,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]黔西南州妇幼保健院药剂科,贵州兴义562400 [2]贵州省人民医院全科医学科,贵阳550002 [3]贵州省人民医院药剂科,贵阳550002

出　　处：《抗感染药学》2025年第1期11-17,共7页Anti-infection Pharmacy

摘　　要：目的:探讨原发性侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)继发大动脉炎(Takayasu's arteritis,TAK)的诊疗策略与药学监护要点,为临床此类疑难病患的诊断和治疗提供参考。方法与结果:患者因腹痛伴发热入院,根据白细胞计数、中性粒细胞百分比、C反应蛋白等实验室指标和CT检查结果,初步判断为肺部感染和TAK,随即予经验性抗感染治疗;但先后予莫西沙星、哌拉西林-他唑巴坦钠、美罗培南、卡泊芬净治疗7 d,患者发热和感染指标均未明显好转,其间未获得明确的病原学结果,故考虑抗真菌治疗应答不佳,遂将卡泊芬净替换为伏立康唑;第8天起,患者体温开始恢复正常,感染指标也逐步下降,其间G试验和GM试验两次回报阳性,曲霉IgG抗体亦报阳性,结合患者近2年多次肺部真菌感染的情况,加之其建筑工人长期暴露于粉尘环境的工作特点,判断肺部感染为原发性IPA,而TAK为其继发疾病,遂嘱患者坚持伏立康唑治疗;治疗3个月后,影像学检查显示患者病灶基本吸收,实验室指标也已恢复正常。结论:对于不明原因的感染,临床药师在协助医生开展经验性抗感染治疗的同时应积极探寻病原体,以使治疗更有针对性;而对于真菌感染,临床应给予患者充足的疗程,以保证患者获得有效的治疗,并减少复发。Objective:To explore the diagnosis and treatment strategy and pharmaceutical care key points for Takayasu's arteritis(TAK)secondary to primary invasive pulmonary aspergillosis(IPA),and provide reference for the diagnosis and treatment of patients with such difficult diseases.Methods and Results:The patient was admitted to hospital due to abdominal pain and fever.According to the laboratory indexes such as white blood cell count,neutrophil percentage,C-reactive protein and CT examination results,pulmonary infection and TAK were initially diagnosed,and then empirical anti-infective treatment was given.However,after 7 days of treatment with moxifloxacin,piperacillin tazobactam sodium,meropenem and caspofungin successively,the fever and infection indicators of the patients did not improve significantly,and no clear etiological results were obtained during this period.Therefore,it is considered that the response to antifungal therapy was poor,and caspofungin was replaced by voriconazole.On the 8th day,the body temperature of the patient began to return to normal,and the infection indicators also gradually decreased,during which the G test and GM test returned positive twice,and the Aspergillus IgG antibody also reported positive.Based on the patient's multiple pulmonary fungal infections in the past two years,and the working characteristics of the construction worker exposed to dust environment for a long time,the pulmonary infection was judged as a primary IPA,and TAK was a secondary disease,and the patient was instructed to persist in voriconazole treatment.After three months of treatment,imaging examination showed that the patient's lesion was basically absorbed,and the laboratory indexes had returned to normal.Conclusion:For the infection of unknown cause,clinical pharmacists should actively explore the pathogen while assisting doctors to carry out empirical anti-infective treatment,so as to make the treatment more targeted.For fungal infections,patients should be given sufficient courses of clinical treatment to

关 键 词：原发性侵袭性肺曲霉病 大动脉炎 抗感染治疗 药学监护 临床药师 

分 类 号：R97[医药卫生—药品] R519[医药卫生—药学]