摘要
目的分析无基础疾病的肺曲霉病患者的临床特征,提高对该病的认识及诊治。方法选取2009年1月—2019年1月郑州大学第一附属医院无基础疾病的肺曲霉病患者为研究对象,对相关资料进行回顾性分析。所有患者均获得病理学诊断依据。结果52例患者中,侵袭性肺曲霉病临床症状出现时间多在10~15 d,慢性坏死性肺曲霉病和肺曲霉球临床症状出现时间多在1~2个月。侵袭性肺曲霉病以发热、咳嗽、咯痰、咯血、胸痛多见,占53.8%(14/26);慢性坏死性肺曲霉病以咳嗽、咯痰、痰中带血多见,占76.2%(16/21),少数(3例)合并发热和(或)胸痛,2例无任何症状;肺曲霉球多以咯血(占4/5)为唯一症状,1例合并咳嗽。实验室检查中出现C反应蛋白、降钙素原升高和红细胞沉降率加快的比例分别为32.7%(17/52)、28.8%(15/52)和34.6%(18/52),G试验、GM试验等指标仅少数患者出现升高,占15.0%。影像学表现为侵袭性肺曲霉病病变多位于双肺,占57.7%(15/26),且多表现为炎症伴周围炎性渗出,占69.2%(18/26);慢性坏死性肺曲霉病和肺曲霉球病变多位于单肺,分别占85.7%和5/5,且二者多表现为结节伴空洞。及时行抗真菌治疗或手术后,98.1%(51/52)的患者症状和(或)影像学好转后出院,治疗效果相对较好。结论无基础疾病的肺曲霉病临床特征不典型,尤其是慢性坏死性肺曲霉病和肺曲霉球,极易与肿瘤混淆,在诊断不明时,及时选择合适的确诊方法,为尽早治疗提供依据,以改善转归。
Objective To analyze the clinical features of pulmonary aspergillosis in patients without underlying diseases for improving the diagnosis and treatment of this disease.Methods From January 2009 to January 2019,patients with pulmonary aspergillosis treated in the First Affiliated Hospital of Zhengzhou University were selected as study subjects.The relevant data were analyzed retrospectively.Pathologic diagnosis was obtained for all patients.Results The onset time was 10-15 days for the clinical symptoms of invasive pulmonary aspergillosis,and mostly 1-2 months for the clinical symptoms of chronic necrotizing pulmonary aspergillosis and aspergillus fungus ball.Fever,cough,sputum,hemoptysis,and chest pain were the most common symptoms of invasive pulmonary aspergillosis(53.8%,14/26).Cough,sputum,and bloody sputum were reported in most(76.2%,16/21)of the patients with chronic necrotizing pulmonary aspergillosis.Three patients had fever and/or chest pain,and 2 patients did not have any symptoms.Hemoptysis was usually the only symptom of pulmonary aspergillus ball(4/5).The remaining one patient had cough.Increased C-reactive protein,procalcitonin,and erythrocyte sedimentation rate were found in 32.7%(17/52),28.8%(15/52),and 34.6%(18/52)of the patients,respectively.Only a few patients(15.0%)had positive G test and GM test.Imaging studies indicated that invasive pulmonary aspergillosis lesions were mostly located in both lungs(57.7%,15/26),associated with inflammation and peripheral inflammatory exudation(69.2%,18/26).Chronic necrotizing pulmonary aspergillosis and pulmonary aspergillus ball were mostly located in unilateral lung,associated with nodules and cavities(85.7%and 5/5).Timely antifungal therapy or surgery resulted in good outcome evidenced by clinical and radiological improvement in 51 patients(98.1%).Conclusions The clinical manifestations of pulmonary aspergillosis are atypical in patients without underlying diseases,especially chronic necrotizing pulmonary aspergillosis and pulmonary aspergillus ball,which
作者
李艳娟
朱静静
葛路路
马东波
汪洋
王静
吴秋歌
LI Yanjuan;ZHU Jingjing;GE Lulu;MA Dongbo;WANG Yang;WANG Jing;WU Qiuge(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第2期165-168,共4页
Chinese Journal of Infection and Chemotherapy
基金
河南省医学科技攻关计划普通项目(201602045)。
关键词
肺曲霉病
病理确诊
临床特征
pulmonary aspergillosis
pathological diagnosis
clinical feature
