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慢性气道疾病合并侵袭性肺曲霉病临床分析

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DOI:
作者:
戴然然，张旻
dairanran，zhangmin
作者单位:
上海交通大学医学院附属瑞金医院呼吸科，上海交通大学附属第一人民医院
Pulmonary Department,Ruijin Hospital,Shanghai Jiaotong University,School of Medicine Pulmonary Department,Shanghai Jiaotong University Affiliated First People's Hospital
关键词:
慢性气道疾病 慢性阻塞性肺疾病 支气管哮喘 支气管扩张 侵袭性肺曲霉病
Chronic airway diseases, Chronic obstructive pulmonary diseases, Bronchial asthma, Bronchiectasis
摘要:
摘要 目的 对慢性气道疾病合并侵袭性肺曲霉病作临床分析。方法 回顾性分析2007年1月至2012年8月在两所教学医院收治的慢性气道疾病合并侵袭性肺曲霉病患者的临床资料。分析慢性气道疾病患者合并侵袭性肺曲霉病的危险因素、临床表现、实验室检查、影像学特征以及诊断、治疗和预后等。结果 共有18例慢性气道疾病患者合并侵袭性肺曲霉病，2例确诊IPA，16例临床诊断IPA，男性14例，女性4例，年龄29—80岁，平均62.2岁。慢性阻塞性肺疾病患者13例，支气管哮喘3例，支气管扩张2例。长期、反复使用糖皮质激素，严重的肺部疾病，反复使用抗菌药物是发生侵袭性肺曲霉病的主要危险因素。临床和影像学无特异性。所有患者均接受了抗真菌药物治疗，其中6例患者死于IPA和呼吸衰竭。 结论 慢性气道疾病容易合并严重的IPA，大部分患者由于基础疾病急性加重反复使用糖皮质激素治疗，临床和影像学无特异性，当临床高度怀疑IPA时应给予尽早诊断和治疗，可以降低病死率。
Abstract Objective: Clinical analysis of chronic airway diseases with IPA. Method: We retrospectively analyze the clinical data of the patients of chronic airway diseases with IPA from January 2007 to August 2012 in two teaching hospitals. We also analyze the risk factors, clinical features, diagnostic methods, radiological findings, treatment and outcome. Result: There were 18 cases of chronic airway diseases with IPA. The diagnosis of IPA was definite in 2 cases and probable in 16 cases. There were 14 male patients and 4 female patients. The age ranged from 29 to 80 and the mean age was 62.2 years old. There were 13 cases of COPD, 3 cases of bronchial asthma and 2 cases of bronchiectasis. Long-term and repeated use of systemic corticosteroid therapy, severe pulmonary diseases, repeated use of antibiotics are the main risk factors to chronic airway diseases with IPA. The clinical and radiological presentation is nonspecific. All Bthe 18 patients were treated with anti-fungal drugs, among them 6 were dead from IPA and respiratory failure. Conclusion: IPA is an emerging serious infection in patients with COPD. The majority of these patients have advanced chronic airway diseases and on corticosteroid therapy. The clinical and radiological presentation is nonspecific. When IPA is highly suspected, timely diagnosis and treatment is necessary so as to reduce mortality.

 

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