肺曲霉病40例的临床分析

目的：探讨肺曲霉病的临床表现、影像学特点、诊断和治疗，以提高对本病的认识。方法：回顾性分析本院2002年1月-2009年4月经病理确诊为肺曲霉病住院患者40例，总结其临床表现、影像学特点、诊断及治疗情况。结果：40例肺曲霉病患者中，曲菌球23例、侵袭性肺曲霉病17例。合并有基础疾病者36例（90．0％）：其中，肺结核15例（37．5％），支气管扩张6例（15．0％）。肺曲霉病的主要症状为咳嗽32例（80．0％），咳痰25例（62．5％），咯血24例（60．0％0。影像学表现多样，肿块结节型23例（57．5％），渗出型12例（30．0％）空洞样病灶12例（30．0％），“洞中球征”和“晕征”各8例（20．0％）。所有病例均经过病理检出，手术切除后病理检出26例（65．0％），纤维支气管镜下活检栓出12例（30．0％），CT引导下经皮肺穿刺活检检出2例。本组病例中，26倒在病理诊断前被初诊误诊，误诊率高达65．0％，初诊为肺结核13例（32．5％），肺癌8例（20．0％），细菌感染3例，支气管扩张并感染2例。26例（65．0％）经外科手术切除，随访均无复发；10例（25．O％）经抗真菌药物治疗，9例痊愈或显效。结论：肺曲霉病多继发于肺部基础疾病，临床表现以咳嗽、咳痰、反复间断咯血为主，缺乏特异性；影像学表现复杂多样。曲菌球和侵袭性肺曲霉病的发病危险因素、临床表现、影像学以及治疗方法均有不同。肺曲霉病误诊率高，确诊有赖于组织病理学；外科治疗和抗真菌药物治疗有较好的疗效。

Clinical Analysis of 40 Patients with Pulmonary Aspergillosis

Objective： To investigate the clinical manifestations, imaging features, diagnosis and managements of pulmonary aspergillosis （PA）. Methods： 40 patients with PA, identified by pathological examinations, in our hospital from January 2002 to April 2009 were studied retrospectively. Clinical manifestations, imaging features, diagnostic methods and managements were analyzed. Results： 23 cases were aspergilloma, 17 cases were invasive pulmonary aspergillosis. 36 of 40 cases （90.0%） had underlying diseases, 15 cases （37.5%） of tuberculosis, 6 cases （15.0%） of bronchiectasia. Main symptoms include： cough 32 cases （80.0%）, expectoration 25 cases （62.5%）, haemoptysis 24 cases （60.0%）. The X-ray and chest CT showed masses or nodules lesions （23 cases, 57.5%）, patchy lesions （12 cases, 30.0%）, cavitary lesions（12 cases, 30.0%）, ＂halo sign＂ （8 cases, 20%） and ＂crescentic sign＂ （8 cases, 20%）. All the patients were i- dentified by pathological examinations. 26 cases （65.0%） obtained lung or bronchi tissues by operation, 12 cases （30.0%） by bronchofibroscope, 2 cases by CT-guided percutaneous needle biopsy. Among 40 cases, 26 cases（65.0%） were misdiagnosised before pathological examinations, 12 cases （32.5%） were misdiagnosised as tuberculosis, 8 cases （20.0%） were misdiagnosised as lung cancer, 3 cases were misdiagnosised as pneumonia, 2 cases was misdiagnosised as bronchiectasia. 26 cases （65.0%） underwent surgical resection of pul- monary lesions. No one recured after operation. 10 cases （25.0%） received systemic anti-fugal therapy, 9 cases were recovery or excellence. Conclusions： Most of PA had underlying diseases. Cough, expectoration, repeated, interrupted haemoptysis were main manifestations which were non-specificity. The X-ray and chest CT results were confusion. Risk factors, clinical manifestation, imaging or therapy were different between aspergilloma and invasive pulmonary aspergillosis. PA was usually misdiagnosed. Final diagnosis was mainly depended on pathological examinations. Satisfactory results can be obtained by both anti-fungi treatments and surgical treatment.