摘要
目的通过分析肺曲霉病患者的临床特点,提高对本病的诊治水平,制定合理的治疗方案。方法收集福建省老年医院2010年1月-2017年12月65例肺曲霉病患者的临床资料进行回顾性研究,研究对象分为曲霉菌感染组和无曲霉菌感染对照组。通过分析肺曲霉菌感染患者的宿主因素、基础疾病等相关因素,得出肺曲霉菌感染的独立危险因素。同时,分析感染患者CT表现、病原学检查、病理形态及治疗转归等情况。结果 1.65例患者确诊24例(36.9%),临床诊断41例(63.1%),65例患者均伴有基础疾病。感染组与对照组一般资料具有可比性(t=0.58,P=0.034)。2.经logistic回归分析发现抗菌素使用时间(OR=3.220),重症肺炎(OR=3.121),慢性阻塞性肺病>C组(OR=3.062),糖皮质激素应用(OR=2.918)是肺曲霉菌感染的密切危险因素。3.肺部CT表现:多发病灶39例,空洞25例,斑片影24例,结节21例,晕征17例,支气管充气征13例,实变11例,团块9例,新月征4例。4.65例患者真菌培养以烟曲霉为主要致病菌66.2%(43/65),痰培养阳性率为32.3%(21/65),肺泡灌洗液阳性率为63.2%(24/38),GM试验阳性率为30.9%(13/42),支气管镜肺活检阳性率为80.9%(17/21),经皮肺穿刺活检阳性率为71.4%(5/7)。5.按药敏试验和经验性,以伏立康唑作为一线抗真菌药,其中治愈或好转者60.0%(39/65),自动出院24.62%(16/65),病死率15.38%(10/65)。结论肺曲霉病仍以烟曲霉为主要致病菌,危险因素多,预后差,故需早期诊断、早治疗,以降低患者病死率。
Objective To analyze the clinical features of patients with pulmonary aspergillosis and improve the diagnosis of this disease so as to make rational treatment plan. Methods The clinical features of 65 cases of pulmonary aspergillosis were analyzed retrospectively in Fujian Provincial Geriatric Hospital from January 2010 to December 2017. We set up an infection group and set up 85 patients without Aspergillus infection as the control group. Through the analysis of the host factors,basic diseases and other related factors in patients with pulmonary aspergillus infection,and ultimately found independent risk factors for pulmonary aspergillosis. At the same time,the CT manifestations,etiological examinations,pathological modalities,and treatment outcomes of infected patients were analyzed. Results 1. Twenty four patients were diagnosed, forty one were clinically diagnosed,and all were associated with underlying disease. Infectious and control groups have comparable general data ( t = 0. 58,P = 0. 034). 2. The logistic regression analysis showed that antibiotic use time ( OR =3. 220),severe pneumonia ( OR = 3. 121),chronic obstructive pulmonary disease > C group ( OR = 3. 062),and glucocorticoid application ( OR = 2. 918) were pulmonary aspergillus infections risk factors. 3. CT manifestations of the lung: 39 cases with multiple lesions,25 cases with cavities,24 cases with patches,21 cases with nodules,17 cases with halo sign,13 cases with bronchial air inflation sign,11 cases with consolidation,9 cases with lumps,and new moon 4 cases. Sixty-five patients had fungus culture with aspergillus fumigatus as the main pathogen 66. 2%( 43 /65),sputum culture positive rate was 32. 3%( 21 /65),bronchoalveolar lavage fluid positive rate was 63. 2%( 24 /38),GM The positive rate of the test was 30. 9%( 13 /42). The positive rate of bronchoscopic lung biopsy was 80. 9%( 17 /21). The positive rate of percutaneous lung biopsy was 71. 4%( 5 /7). 5. According to drug susceptibility test and experience,voriconazole was used as the firstline antifungal agent,among which 60. 0%( 39 /65) were cured or improved,and discharged automatically by the patient 24. 62%( 16 /65). Mortality rate was 15. 38%( 10 /65). Conclusion Aspergillus fumigatus is still the main pathogen of Aspergillus fumigatus,with many risk factors and poor prognosis. Therefore,early diagnosis and early treatment are needed to reduce the mortality rate of patients.
作者
张美泉
Zhang Meiquan(Department of Respiratory Diseases,Fujian Provincial Geriatric Hospital,Fuzhou 350003)
出处
《辽宁医学杂志》
2019年第1期63-67,共5页
Medical Journal of Liaoning
关键词
肺曲霉病
感染
危险因素
Pulmonary aspergillosis
Infection
Risk factors
