肺结核并发肺曲霉菌感染的临床资料分析
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摘要
目的回顾性分析侵袭性和寄生性肺曲霉菌感染的肺结核患者的相关资料,为临床研究提供参考。方法收集2015年1月-2016年12月期间重庆市第六人民医院收治的感染侵袭性和寄生性肺曲霉菌的肺结核病例71例,分析其一般资料、临床症状、肺部CT表现、实验室检查等资料。结果 71例患者中,寄生性肺曲霉菌感染49例(69.02%),侵袭性肺曲霉菌感染22例(30.98%)。前者临床表现以咯血为主,后者以发热、咳嗽、咳痰为主,二者临床表现差异有统计学意义(P <0.05);在CT表现上,两者均以单个病灶、单叶病灶为主,但在病灶形态特征、边缘特征、影像特征等有显著性差异,且有统计学意义(P <0.05)。结论侵袭性和寄生性肺曲霉菌感染的肺结核病例的临床表现、CT表现差异明显,联合组织病理学、曲霉菌培养等可提高诊断准确率。
Objective To retrospectively analyze the data of the diagnosis of pulmonary tuberculosis patients with invasive and parasitic pulmonary aspergillosis,so as to provide reference for clinical research. Methods A total of 71 patients of invasive and parasitic pulmonary aspergillosis in Chongqing Sixth People's Hospital from January 2015 to December 2016 were collected. The general information,clinical symptoms,CT manifestations and laboratory tests were analyzed. Results Among the 71 patients,49 cases(69.02%) were parasitic pulmonary aspergillosis and 22(30.98%)were invasive pulmonary aspergillosis. Hemoptysis was the main clinical manifestation of the former,while fever,cough and expectoration were the main clinical manifestations of the latter. There was significant difference between the two groups(P < 0.05). In CT image features single focus and single lobe focus was the main manifestations of the two groups,but there were significant differences in the morphological,marginal and imaging features of the focus(P < 0.05).Conclusion The clinical manifestations and CT image features of pulmonary tuberculosis patients with invasive and parasitic pulmonary Aspergillus infection differ significantly. The diagnostic accuracy can be improved combined with pathology and Aspergillus culture.
Objective To retrospectively analyze the data of the diagnosis of pulmonary tuberculosis patients with invasive and parasitic pulmonary aspergillosis,so as to provide reference for clinical research. Methods A total of 71 patients of invasive and parasitic pulmonary aspergillosis in Chongqing Sixth People's Hospital from January 2015 to December 2016 were collected. The general information,clinical symptoms,CT manifestations and laboratory tests were analyzed. Results Among the 71 patients,49 cases(69.02%) were parasitic pulmonary aspergillosis and 22(30.98%)were invasive pulmonary aspergillosis. Hemoptysis was the main clinical manifestation of the former,while fever,cough and expectoration were the main clinical manifestations of the latter. There was significant difference between the two groups(P < 0.05). In CT image features single focus and single lobe focus was the main manifestations of the two groups,but there were significant differences in the morphological,marginal and imaging features of the focus(P < 0.05).Conclusion The clinical manifestations and CT image features of pulmonary tuberculosis patients with invasive and parasitic pulmonary Aspergillus infection differ significantly. The diagnostic accuracy can be improved combined with pathology and Aspergillus culture.
引文
[1]隆莉,张晓芳,刘娴,等.肺结核患者合并肺曲霉菌感染的临床特征分析[J].医学理论与实践,2017,30(23):362-364.
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[9]李瀛.肺结核合并曲霉菌病感染的CT表现及分析[J].现代诊断与治理,2015,26(1):157-158.
[10] Addrizzo-Harris DJ,Harkin TJ,McGuinness G,et al. Pulmonary aspergilloma and AIDS:a comparison of HIV infected and HIV negative individuals[J].Chest,2016,11(1):612-618.
[11] Bandoh S,Fujita J,Fukunaga Y,et al. Cavitary lung cancer with an aspergilloma-like shadow[J]. Lung Cancer,2016,26(4):195-198.
[12]杜江,张林. 58例肺曲霉菌病患者的临床特点及预后影响因素分析[J].山东医药,2015,55(10):45-47.
[13]林彬,陈溶,杜明良,等.侵袭性肺曲霉菌感染的螺旋CT特征与预后分析[J].中华医院感染学杂志,2016,26(2):280-282.
[14] Bosken CH,Myers JL,Greenberger PA,et al. Pathologic features of allergic bronchopulmonary aspergillosis[J].Am J Surg Pathol,2016,12(4):216-222.
[15] Agarwal R,Gupta D,Aggarwal AN,et al. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis[J].Chest,2014,132(54):1183-1190.
[16]杨创勃,贺太平,聂永康,等.变态反应性支气管肺曲霉菌病的CT表现[J].实用放射学杂志,2015,31(3):402-404.
[17]杨仁恒.慢性阻塞性肺疾病并侵袭性肺曲霉菌病患者的临床表现及胸部CT表现分析[J.]实用心脑肺血管病杂志,2016,24(1):105-107.
[18]甘文忠,张盛.多层螺旋CT对侵袭性肺曲霉菌感染病灶分布及征象显示特征分析[J].医学综述,2016,22(13):2666-2669.
[2] Kawamura S,Maesaki S,Tomono K,et al. Clinical evaluation of61 patients with pulmonary aspergilloma[J].Intern Med,2015,39(4):209-212.
[3]李余良.肺结核合并肺曲霉菌感染的临床病理学分析[J].中外医疗,2015,10(32):71-73.
[4]中华医学会.临床诊疗指南[M].北京:人民卫生出版社,2005.
[5]中国侵袭性真菌感染工作组.侵袭性真菌感染的诊断标准与治疗原则(第3次修订)[J].中华内科杂志,2010,49(6):451-454.
[6]中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J].中华内科杂志,2008,45(22):697-700.
[7] Tomee JF,van der Werf TS,Latge JP,et al. Serologic monitoring of disease and treatment in a patient with pulmonary aspergilloma[J]. Am J Respir Crit Care Med,1995,151(1):199-204.
[8]何彦,周旭东.义乌地区肺结核合并肺曲霉菌感染的病理分析[J].中国地方病防治杂志,2015,30(2):142-143.
[9]李瀛.肺结核合并曲霉菌病感染的CT表现及分析[J].现代诊断与治理,2015,26(1):157-158.
[10] Addrizzo-Harris DJ,Harkin TJ,McGuinness G,et al. Pulmonary aspergilloma and AIDS:a comparison of HIV infected and HIV negative individuals[J].Chest,2016,11(1):612-618.
[11] Bandoh S,Fujita J,Fukunaga Y,et al. Cavitary lung cancer with an aspergilloma-like shadow[J]. Lung Cancer,2016,26(4):195-198.
[12]杜江,张林. 58例肺曲霉菌病患者的临床特点及预后影响因素分析[J].山东医药,2015,55(10):45-47.
[13]林彬,陈溶,杜明良,等.侵袭性肺曲霉菌感染的螺旋CT特征与预后分析[J].中华医院感染学杂志,2016,26(2):280-282.
[14] Bosken CH,Myers JL,Greenberger PA,et al. Pathologic features of allergic bronchopulmonary aspergillosis[J].Am J Surg Pathol,2016,12(4):216-222.
[15] Agarwal R,Gupta D,Aggarwal AN,et al. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis[J].Chest,2014,132(54):1183-1190.
[16]杨创勃,贺太平,聂永康,等.变态反应性支气管肺曲霉菌病的CT表现[J].实用放射学杂志,2015,31(3):402-404.
[17]杨仁恒.慢性阻塞性肺疾病并侵袭性肺曲霉菌病患者的临床表现及胸部CT表现分析[J.]实用心脑肺血管病杂志,2016,24(1):105-107.
[18]甘文忠,张盛.多层螺旋CT对侵袭性肺曲霉菌感染病灶分布及征象显示特征分析[J].医学综述,2016,22(13):2666-2669.