15例肺曲霉菌病临床的研究.docVIP

15例肺曲霉菌病临床的研究 　　【摘要】 目的 探讨肺曲霉菌病的临床表现、影像学特点及诊断治疗。方法 回顾分析2004年1月至2010年12月广东江门市中心医院诊断为肺曲霉菌病的住院患者共15例,总结其临床表现、影像学特点、诊断及治疗情况。结果 15例患者均在原发病的基础上合并感染，其中侵袭性肺曲霉菌病10例，曲菌球菌病4例，变态反应性支气管肺曲霉菌病1例。主要症状为咳嗽、咳痰、发热、气促和咯血。胸部CT病灶形态可为实变、淡薄影、多形性变，部分出现肺门、纵膈淋巴结肿大及胸腔积液。12例（12/15）初诊误诊，8例（8/15）通过肺组织发现曲霉菌丝或曲霉菌的培养确诊。10例（10/15）患者治愈或好转。结论 肺曲霉菌病多继发于全身基础疾病；临床表现特异性低，影像学表现多样。提高早期确诊率、恰当治疗可提高疾病预后。 　　【关键词】 肺曲霉菌病；临床表现；诊断；治疗 　　Clinical analysis of 15 patients with pulmonary aspergillosis LIANG Li-ping, ZUO Wan-li, ZHOU Yan-bin,et al.Department of Respiratory Medicine, Jiangmen Central Hospital,Guangdong 509030,China 　　【Abstract】 Objective To explore the clinical manifestations, imaging features, diagnosis and managements of pulmonary aspergillosis （PA）. Methods 15 patients with PA admitted to Jiangmen Central hospital from January 2004 to December 2010 were reviewed retrospectively. Clinical manifestations, imaging features, diagnostic methods and managements were analyzed. Results 10 cases were invasive pulmonary aspergillosis, 4 cases were aspergilloma and 1 case was allergic bronchopulmonary aspergillosis. All of these had underlying diseases. Most of these patients experienced cough, expectoration, fever, shortness of breath and hemoptysis. Chest CT lesions included a consolidation, thin film, pleomorphic changes, portion hilar, mediastinal lymphadenopathy and pleural effusion. 12 cases were misdiagnosed at first and the diagnosis of 8 cases was confirmed by etiology. 10 cases were cured or improved. Conclusion The risk of PAinfection increased in patients with basic diseases. The clinical manifestations and the results of X-ray and chest CT are no-specific and confused in patients with PA. The cure rate may be improved by early diagnosis and proper managements. 　　【Key words】 Pulmonary aspergillosis; Clinical manifestations Diagnosis; Treatment 　　作者单位：529000 江门市中心医院 　　 　　近年来随着广谱抗菌药物、糖皮质激素、细胞毒性药物及免疫抑制剂的广泛应用，侵袭性肺部真菌感染（IPFI）有增多趋势，并且其病原菌的流行病学也发生了显著改变，近年来，侵袭性肺曲霉菌病（IPA）的报道逐渐增加，其侵袭性强，肺组织破坏严重，在呼吸道真菌感染中危