慢性坏死性肺曲霉病18例临床分析

目的 探讨慢性坏死性肺曲霉病（CNPA）的临床特征、诊断与治疗，以提高对该病的认识。方法 对2003年1月-2006年3月广州呼吸疾病研究所经病理证实的18例慢性坏死性肺曲霉病住院病例进行回顾性研究，结合文献分析其临床表现、影像学、诊断和治疗方法。结果CNPA症状无特异性，主要表现为咳嗽、咳痰18例（100.0％），咯血9例（50.0％），咳血痰1例（5．6％），发热7例（38．9％），气促5例（27．8％），盗汗3例（16．7％），胸痛3例（16.7％），消瘦3例（16．7％），疲乏无力2例（11.1％）。右肺病变5例（27．8％），左肺病变11例（61．1％），双肺受累2例（11.1％）。病灶位于下肺6例（33．3％），上中肺9例（50.0％），双肺弥漫病变1例（5．6％），双肺多发空洞1例（5．6％），左侧毁损肺1例（5．6％），不常见的胸膜（腔）受累共4例。“空气新月征”有提示诊断意义，在本组中发现8例（44.4％）。全部病例均经病理确诊，其中经支气管肺组织活检确诊7例。结论CNPA临床表现无特异性，影像学检查在诊断中起重要作用，而诊断需要病理依据。存在肺部基础疾病，出现发热、血痰及空气新月征三联征时，应高度警惕CNPA。系统抗真菌治疗无效、合并大咯血或肺部阴影与肿瘤不能鉴别时，可考虑手术切除。

Chronic necrotizing pulmonary aspergillosis:analysis of 18 cases

Objective To review clinical manifestation,diagnosis and treatment in patients with chronic necrotizing pulmonary aspergillosis (CNPA).Methods A retrospective analysis of 18 patients with CNPA confirmed histopathologically studies.All patients were admitted to the Guangzhou Institute of Respiratory Disease during 2003~2006.Results The clinical manifestation of CNPA were non-specific. Common presentation included cough (18 cases,100.0),haemoptysis (10cases,55.6),fever (7cases,38.9),dyspnea (5cases,27.8),night-sweat (3cases,6.7),chest pain (3cases,16.7),emaciation (3cases,16.7) and adynamia (2cases,11.1).Pulmonary lesions occurred in right side were presented in 5 cases,left side in 11,and bilateral sides in 2.Bilateral polycavitates were presented in 1case,tuberculous destroyed lung in 1 case.Radiographically,the air crescent sign was suggestive of the diagnosis,which was found in 8 patients (44.4).The diagnosis was confirmed in all cases by pathological findings.Conclusions The clinical manifestation of CNPA are non-specific.Radiography plays a pivotal role in the diagnosis of CNPA.Treatment with antifungal medications is indicated once the diagnosis was made.Pulmonary resection should be considered when patients have prolonged illness or frequent haemoptysis.