摘要
目的探讨2型糖尿病合并侵袭性肺曲霉病(IPA)患者的临床特点,提高对该病的认识及诊疗水平。方法选取2009年1月至2019年1月经郑州大学第一附属医院病理确诊为2型糖尿病合并IPA的17例患者作为观察组,同时选取该时期郑州大学第一附属医院经病理确诊为无基础疾病IPA的52例患者作为对照组,回顾性分析两组的临床资料。所有患者均接受CT引导下经皮肺穿刺或经支气管壁肺活检(TBLB)或胸腔镜下病肺切除。结果两组临床症状(咳嗽、咳痰、胸闷、胸痛、发热、呼吸困难、痰中带血及咯血)比例比较,差异无统计学意义(均P>0.05)。观察组红细胞计数降低、血红蛋白降低、C反应蛋白(CRP)升高、血沉(ESR)增快、降钙素原(PCT)升高、白蛋白降低及实变影比例均高于对照组(均P<0.05)。观察组占位比例低于对照组(P<0.05)。两组中3种确诊方式(TBLB、CT引导下经皮肺穿刺、胸腔镜下病肺切除)比较,差异无统计学意义(均P>0.05)。经过15~30 d正规抗真菌治疗或手术后,两组转归比较,差异无统计学意义(均P>0.05)。结论2型糖尿病合并IPA患者相较无基础疾病IPA患者,机体炎症反应和消耗可能更严重,更易合并细菌感染,需要引起重视,在患者一般情况允许时,尽早获得病理学证据,及时抗真菌治疗,转归相对较好。
Objective To explore the clinical features of patients with type 2 diabetes with invasive pulmonary aspergillosis(IPA),and to improve the level of diagnosis and treatment of the disease.Methods A total of 17 patients with type 2 diabetes with IPA diagnosed by pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to January 2019 were selected as observation group,and 52 patients with IPA without underlying diseases by pathology in the First Affiliated Hospital of Zhengzhou University were selected as control group during the same period.The clinical data of the two groups were retrospectively analyzed.All patients underwent CT-guided transcutaneous lung puncture or transbronchial wall lung biopsy(TBLB)or thoracoscopic lung resection.Results There were no statistical differences on the proportions of clinical symptoms(cough,expectoration,chest distress,chest pain,fever,dyspnea,blood in sputum and hemoptysis)between the two groups(all P>0.05).The proportions of red blood cell count decrease,hemoglobin decrease,C reactive protein(CRP)increase,erythrocyte sedimentation rate(ESR)increase,procalcitonin(PCT)increase,albumin decrease and consolidation in observation group were all higher than those in control group(all P<0.05).The proportion of placeholder in observation group was lower than that in control group(P<0.05).There were no statistical differences on three ways of diagnosis(TBLB,CT-guided transcutaneous lung puncture and thoracoscopic lung resection)between the two groups(all P>0.05).After 15 to 30 days of normal antifungal therapy or surgery,there was no statistical difference in the outcome between the two groups(P>0.05).Conclusion Patients with type 2 diabetes with IPA compared with patients with IPA without underlying diseases may have more severe inflammatory reaction and consumption and may be more susceptible to bacterial infection.They need to be paid attention to.When the patients’general conditions allow,pathological evidence is obtained as early as possible and antifungal treatment is carried out in time,and the outcome is relatively good.
作者
李艳娟
朱静静
葛路路
马东波
汪洋
王静
吴秋歌
LI Yan-juan;ZHU Jing-jing;GE Lu-lu;MA Dong-bo;WANG Yang;WANG Jing;WU Qiu-ge(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2020年第25期4626-4629,共4页
Henan Medical Research
基金
河南省医学科技攻关计划普通项目(201602045)。
关键词
2型糖尿病
侵袭性肺曲霉病
临床特点
type 2 diabetes
invasive pulmonary aspergillosis
clinical features
