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慢性阻塞性肺疾病合并侵袭性肺曲霉病53例临床分析

The clinical features of invasive pulmonary aspergillosis in 53 chronic obstructive pulmonary disease patients

摘要:

目的 分析慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(IPA)的临床特点,为早期诊断和治疗提供依据.方法 回顾性分析53例临床诊断的COPD合并IPA患者的临床资料、诊断、治疗及转归.结果 53例COPD合并IPA患者均有使用广谱抗生素史,全身使用糖皮质激素2周以上者43例,存在明显喘息者51例,发热20例.影像学早期无特征性改变,病情进展后胸部CT表现为双肺斑片状渗出影或融合成大片实变影32例,伴有单发或多发结节14例,伴有单个或多个空洞4例,晕征2例.真菌病原学检查,痰检阳性率为56.6%(30/53),血清GM实验阳性率为52.8%(28/53).53例COPD合并IPA患者均接受抗真菌治疗,37例行机械通气(24例行无创通气,13例行有创通气).33例病情好转或痊愈,20例治疗半个月后病情无好转或放弃治疗,其中13例死亡,死亡原因为多脏器功能衰竭5例,急性肾衰竭8例.结论 对有大量糖皮质激素应用史、临床存在明显喘息、广谱抗生素治疗无效者,应及时行IPA检查,积极寻找病原学和影像学证据,早期诊断,尽早开始抗真菌治疗,改善COPD合并IPA患者的预后.

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abstracts:

Objective To study the clinical features of invasive pulmonary aspergillosis (IPA) with chronic obstructive pulmonary diseases (COPD),so as to provide evidence for early diagnosis and treatment.Methods A retrospective analysis was made upon clinical data,diagnosis,treatment and prognosis of 53 patients with IPA and COPD admitted between January 2005 and February 2011 collected in a respiratory unit of the Second Xiangya Hospital Affiliated Central South University.Results There were 53 cases of diagnosed as IPA with COPD,with history of using broad-spectrum antibiotics.And there were 43 cases using steroids more than 2 weeks,51 with obvious breathlessness,and 20 with fever.Early stage didn't present characteristical changes on CT scan.However,after disease progression,32 cases had maculas shadows and nonspecific consolidations in bilateral lung,14 with solitary or multiple nodules,4 with solitary or multiple air crescent sign,and 2 with halo sign.Four patients of COPD with IPA underwent bronchoscopy examination.In fungi pathogeny,sputum positive rate and galactomannan positive rate were 56.6% and 52.8%,respectively.A total of 53 cases received antifungal treatment.Among 37 cases which underwent mechanical ventilation,24 received noninvasive ventilation and 13 received invasive ventilation.There were 33 cases which were improved and cured,and 20 cases which had no relief after half-a-month treatment or withdrew treatment.Among them,13 cases died because of multiple-organ failure (5/15) or acute renal failure (8/15).Conclusions Early suspected diagnosis,timely examination in allusion to IPA,actively searching for etiological and imaging evidences,early established diagnosis and antifungal treatment would improve prognosis of patients with COPD combined IPA who have history of high doses of cortieosteroids,obvious breathlessness and non-response to antibiotics.

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