慢性肺曲霉菌病55例临床分析
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摘要
目的分析慢性肺曲霉菌病(CPA)临床特点,为诊断和治疗提供依据。方法回顾性分析55例临床诊断CPA患者的临床资料、影像学特征及实验室检查。结果在诊断为CPA55例患者中,34例诊断为慢性空洞性肺曲霉病,15例亚急性侵袭性肺曲霉菌病,4例单纯性肺曲霉菌球,2例曲霉菌结节。在CPA患者中合并慢性阻塞性肺疾病29例(52.7%),恶性肿瘤6例(10.9%)、肺结核5例(9.1%)、哮喘4例(7.3%)、支气管扩张4例(7.3%)、间质性肺疾病1例(1.8%)。CPA患者最常见症状是咳嗽(94.5%)、咳痰(81.8%)、咯血(54.5%)和发热(36.4%)。最常见胸部CT扫描异常是空腔(96.4%)、结节(63.6%)、渗出或实变(7.3%)和胸膜增厚(5.5%)。结论 CPA患者多合并慢性阻塞性肺疾病、恶性肿瘤、肺结核、哮喘、支气管扩张、间质性肺疾病,慢性空洞性肺曲霉病是CPA患者最常见的类型。积极寻找病原学和影像学证据,必要时行肺穿刺及肺切除手术,尽早开始抗真菌治疗,改善CPA患者的预后。
Objective To study the clinical features of chronic pulmonary aspergillosis(CPA),so as to provide evidence for early diagnosis and treatment. Methods A retrospective analysis was made upon clincial data, imaging features and laboratory tests of 55 patients with CPA. Results Of the 55 patients diagnosed with CPA, 34 patients were diagnosed with chronic cavitary pulmonary aspergillosis,15 patients with semi-invasive aspergillosis,4 patients with simple aspergilloma, and 2 patients with aspergillus nodule. There were 29 cases of chronic obstructive pulmonary disease(52.7%),6 cases of malignant tumor(10.9%),5 cases of pulmonary tuberculosis(9.1%),4 cases of asthma(7.3%),4 cases of bronchiectasis(7.3%) and 1 cases of interstitial lung disease(1.8%) in CPA. The most common symptoms in the CPA patients were cough(94.5%),sputum(81.8%),hemoptysis(54.5%),and fever(36.4%).The most common computerized tomography abnormalities were cavities(96.4%),nodule(63.6%),infiltration or consolidation(7.3%),and pleural thickening(5.5%). Conclusion CPA patients were usually associated with chronic obstructive pulmonary disease, malignant tumor, pulmonary tuberculosis, asthma, bronchiectasis and interstitial lung disease. Chronic cavitary pulmonary aspergillosis was the most common types of CPA. Actively searching for etiological and imaging evidences, including pneumocentesis or pulmonary resection if necessary, early antifungal treatment would improve prognosis of patients with CPA.
Objective To study the clinical features of chronic pulmonary aspergillosis(CPA),so as to provide evidence for early diagnosis and treatment. Methods A retrospective analysis was made upon clincial data, imaging features and laboratory tests of 55 patients with CPA. Results Of the 55 patients diagnosed with CPA, 34 patients were diagnosed with chronic cavitary pulmonary aspergillosis,15 patients with semi-invasive aspergillosis,4 patients with simple aspergilloma, and 2 patients with aspergillus nodule. There were 29 cases of chronic obstructive pulmonary disease(52.7%),6 cases of malignant tumor(10.9%),5 cases of pulmonary tuberculosis(9.1%),4 cases of asthma(7.3%),4 cases of bronchiectasis(7.3%) and 1 cases of interstitial lung disease(1.8%) in CPA. The most common symptoms in the CPA patients were cough(94.5%),sputum(81.8%),hemoptysis(54.5%),and fever(36.4%).The most common computerized tomography abnormalities were cavities(96.4%),nodule(63.6%),infiltration or consolidation(7.3%),and pleural thickening(5.5%). Conclusion CPA patients were usually associated with chronic obstructive pulmonary disease, malignant tumor, pulmonary tuberculosis, asthma, bronchiectasis and interstitial lung disease. Chronic cavitary pulmonary aspergillosis was the most common types of CPA. Actively searching for etiological and imaging evidences, including pneumocentesis or pulmonary resection if necessary, early antifungal treatment would improve prognosis of patients with CPA.
引文
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[5] Al-Shair K,Muldoon EG,Morris J,et al.Characterisation of fatigue and its substantial impact on health status in a large cohort of patients with chronic pulmonary aspergillosis(CPA)[J].Respir Med,2016,114(5): 117-122.
[6] Maghrabi F,Denning DW.The management of chronic pulmonary aspergillosis:The UK National Aspergillosis Centre Approach[J].Curr Fungal Infect Rep,2017,11(4):242-251.
[7] Diamond RD,Haudenschild CC,Erickson NF. Monocyte-mediated damage to Rhizopus oryzae hyphae in vitro[J].Infect Immun,1982,38(1):292-297.
[8] Patterson KC,Strek ME.Diagnosis and treatment of pulmonary aspergillosis syndromes[J].Chest,2014, 146(5):1358-1368.
[9] Imburgia C,Buscemi C,Corrao S. Pulmonary infiltrate with characteristic "reversed halo" and "air crescent" signs[J].Eur J Intern Med,2017,41(6):e3-e4.
[10] Farid S,Mohamed S,Devbhandari M,et al.Results of surgery for chronic pulmonary aspergillosis,optimal antifungal therapy and proposed high risk factors for recurrence-a National Centre's experience[J].J Cardiothorac Surg,2013,8(5):180-186.
[11] Al-Shair K,Atherton GT,Harris C,et al.Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis[J].Clin Infect Dis,2013,57(6):828-835.
[12] Kono Y,Tsushima K,Yamaguchi K,et al.The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis[J].Respir Med,2013,107(7):1094-1100.
[2] 徐媛,陈敏,廖万清.中国侵袭性曲霉菌病流行病学现状[J].中国真菌学杂志,2018,13(1):57-60.
[3] Denning DW,Cadranel J,Beigelman-Aubry C,et al.Chronic pulmonary aspergillosis:rationale and clinical guidelines for diagnosis and management[J].Eur Respir J,2016,47(1):45-68.
[4] Patterson TF,Thompson GR,Denning DW,et al.Practice guidelines for the diagnosis and management of aspergillosis:2016 Update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4): e1-e60.
[5] Al-Shair K,Muldoon EG,Morris J,et al.Characterisation of fatigue and its substantial impact on health status in a large cohort of patients with chronic pulmonary aspergillosis(CPA)[J].Respir Med,2016,114(5): 117-122.
[6] Maghrabi F,Denning DW.The management of chronic pulmonary aspergillosis:The UK National Aspergillosis Centre Approach[J].Curr Fungal Infect Rep,2017,11(4):242-251.
[7] Diamond RD,Haudenschild CC,Erickson NF. Monocyte-mediated damage to Rhizopus oryzae hyphae in vitro[J].Infect Immun,1982,38(1):292-297.
[8] Patterson KC,Strek ME.Diagnosis and treatment of pulmonary aspergillosis syndromes[J].Chest,2014, 146(5):1358-1368.
[9] Imburgia C,Buscemi C,Corrao S. Pulmonary infiltrate with characteristic "reversed halo" and "air crescent" signs[J].Eur J Intern Med,2017,41(6):e3-e4.
[10] Farid S,Mohamed S,Devbhandari M,et al.Results of surgery for chronic pulmonary aspergillosis,optimal antifungal therapy and proposed high risk factors for recurrence-a National Centre's experience[J].J Cardiothorac Surg,2013,8(5):180-186.
[11] Al-Shair K,Atherton GT,Harris C,et al.Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis[J].Clin Infect Dis,2013,57(6):828-835.
[12] Kono Y,Tsushima K,Yamaguchi K,et al.The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis[J].Respir Med,2013,107(7):1094-1100.