侵袭性肺曲霉病临床和病理分析——附23例报告

目的 分析侵袭性肺曲霉病(IPA)临床和组织病理特征,为探讨IPA早期诊断和临床病理分型提供依据.方法 非选择性地总结本院34年来512例成人(年龄≥16岁)尸检资料,依据病理切片真菌形态确定IPA患者共23例,并进行临床和病理对照分析.结果 23例中有明确基础疾病者21例,有明确诱因者20例.临床上表现有发热等中毒症状者17例(73.91%),合并呼吸道症状者18例(78.26%),存在肺部和肺外栓塞征象者9例(3.91%).胸部影像表现和病理检查符合急性支气管肺炎型15例次,血管侵袭型12例次,急性气管支气管炎型5例次,粟粒型3例次和胸膜炎型1例次.其中急性支气管炎型和血管侵袭型常合并存在,并成为患者致死的直接原因.结论 IPA临床表现复杂多变,探讨临床尤其是胸部影像学检查和组织病理分型有利于患者的早期诊断和判断预后.

Invasive pulmonary aspergillosis:a retrospective clinical and pathological analysis of 23 cases at autopsy

Objective To analyse the clinical and pathological characteristics of invasive pulmonary aspergillosis(IPA).Methods Total 512 adult cases at autopsy from 1971-2004 were enrolled for study, and 23 IPA cases diagnosed clearly by tissue section features were further analysed.Results Among 23 IPA cases, 21 cases have underlying diseases and 20 cases have predisposing factors. Seventeen patients got fever and eighteen patients had respiratory symptoms.Nine cases showed various signs of pulmonary embolism and extrapulmonary embolism.Acute bronchopneumonia, angioinvasive aspergillosis, acute tracheobronchitis, miliary aspergillosis and pleural aspergillosis were shown in 15,12,5,3 and 1 cases respectively by clinical radiographic signs and pathological features.The overlape between acute bronchopneumonia, angioinvasive aspergillosis was common,which usually led to death. Conclusion The clinical manifestations of IPA was miscellaneous.It is benefit to investigate the clinical characteristics,especially chest radiographic signs and pathological changes for early diagnosis and prognosis evaluation.