摘要
目的分析侵袭性肺曲霉病(IPA)的临床特征,以期为早期诊断、合理治疗及预防提供依据。方法对解放军454医院经病理检查确诊的14例IPA患者,结合文献分析其基础疾病、症状、体征、X线胸片和CT、病理检查、治疗方案以及疗效等。结果14例患者均合并有基础疾病,其中肺癌5例(35.7%),慢性阻塞性肺疾病3例(21.4%),肺脓肿2例(14.3%),白血病化疗后2例(14.3%),肺结核1例(7.1%);糖尿病1例(7.1%);所有病例均有发热及咳嗽、咯痰,其他常见的症状还有咯血(71.4%)、呼吸急促(57.1%)、盗汗(57.1%)、胸痛(42.9%)等;X线胸片及CT可表现为空气新月征、全肺弥漫性片状或团片状阴影、单发或多发肿块或结节影等;抗真菌药物治疗10例,顺利出院4例,病情进展并死亡4例,自动出院2例,手术治疗4例患者均顺利出院。结论IPA好发于免疫缺陷患者,其临床表现无特异性,X线胸片及CT可见相应征象,确诊有赖病理检查,药物治疗效果欠佳,病程迁延或反复咯血以及不能与肿瘤鉴别者可以考虑手术治疗。
OBJECTIVE To study the clinical characteristics of invasive pulmonary aspergillosis（IPA）.METHODS Based on the clinical data from 14 IPA cases identified by pathologic examination in the 454th Hospital,the characteristics of IPA were discussed,including the underlying diseases,symptoms,X-ray,CT,the treatment methods and the curative effect.The related literatures were also reviewed.RESULTS All of the 14 patients had underlying diseases.From them 5 were with pulmonary cancer（35.7%）,3 with chronic obstructive pulmonary disease（21.4%）,2 with pulmonary abscess（14.3%）,2 were after chemotherapy for leukemia（14.3%）,1 with pulmonary tuberculosis（7.1%）and 1 with diabetes（7.1%）.The common symptoms of the 14 cases were febricity,productive cough and hemoptysis.Some of them also suffered with short of breath,night sweat,fatigue,chest pain and losing weight.The air crescent sign showed on X-ray and CT.Soft tissue masses with halo-sign on the margin,dense shadow of small masses within the alveoli,and multi-nodular shadows were also observed.Among 10 patients treated by antifungal medications,only 4 treated otherwise with operation were cured,4 patients died,and 2 patients did not complete the treatment scheme.CONCLUSIONS The patients with immunodeficiency are susceptible to IPA.The clinical manifestations of IPA are non-specific.The final diagnosis depends on the pathologic examination.The only medication is not sufficient for IPA patients.Pulmonary resection should be considered if the prolonged illness or frequent hemoptysis exist.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2008年第4期505-507,共3页
Chinese Journal of Nosocomiology
关键词
肺曲霉病
诊断
治疗
Pulmonary aspergillosis
Diagnosis
Treatment
