非粒细胞减少患者肺曲霉病22例回顾性分析

目的提高对非粒细胞减少患者肺曲霉病的认识及诊疗水平。方法回顾性分析22例非粒细胞减少患者肺曲霉病的临床、影像学及实验室资料，随诊其转归。结果22例肺曲霉病（PA）患者，男性12例，女性10例，平均年龄（56．3±21．4）岁。确诊、临床诊断各8例，拟诊6例。侵袭性肺曲霉病（IPA）11例，单纯性曲霉球6例，慢性坏死性肺曲霉病（CNPA）5例。常见基础疾病为继发型肺结核（8／22）、糖尿病或类固醇性糖尿病（6／22）、高血压病（5／22）、慢性阻塞性肺疾病（5／22），4例系原发社区感染。常见临床症状咳嗽咳痰（18／22）、咯血（11／22）、气促（7／22）。影像学表现为肺部渗出或实变病灶9例、空洞改变及典型曲霉球12例，结节或肿块1例。首选药物治疗依次为伏立康唑（10／22）、卡泊芬净（4／22）、伊曲康唑（3／22）。结论非粒细胞减少伴IPA好发于糖尿病、慢性阻塞性肺疾病，亦可发生在免疫功能正常患者。单纯曲霉球多继发或并发于肺结核。应注意鉴别CNPA与单纯曲霉球。IPA临床表现缺乏特征性。影像改变未见典型晕征及空气半月征，肺外播散少见，药物治疗首选伏立康唑。

Retrospective analysis of 22 cases of pulmonary aspergillosis in non-neutropenic patients

Objective To improve the cognition,diagnosis and treatment of pulmonary aspergillosis(PA) in non-neutropenic patients.Method Clinical,radiological data of 22 cases of PA in non-neutropenic patients,including underlying diseases,clinical symptoms,radiological characteristics and treatment strategies were collected and analyzed retrospectively,and the outcomes were followed-up.Result The average age was(57.3±21.4) years with 12 male and 10 female.The cases of "proven","probable" and "possible" were 8,8 and 6,respectively.11 patients were considered as having IPA,including 1 with underlying aspergilloma;6 were having simple pulmonary aspergilloma,and 5 CNPA.The leading underlying diseases were pulmonary tuberculosis(8/22),diabetes mellitus(6/22),hypertension(5/22) and chronic obstructive pulmonary disease(COPD)(5/22) in pulmonary aspergillosis(PA).Chronic cough,expectoration,hemoptysis and recurrent dyspnea were the most common symptoms of PA.Radiological manifestations were infiltration or consolidation(10/22),cavity or typical pulmonary aspergilloma(12/22) and nodule or lump mass(1/22).The first-line antifugal treatment was voriconazole(10/22),caspofungin(4/22),itraconazole(3/22).Conclusion Diabetes mellitus and COPD patients are vulnerable to have IPA and patients without underlying diseases may also develop IPA as primary community infection.Pulmonary tuberculosis with cavitary changes is responsible for simple pulmonary aspergilloma.We should pay more attention to differentiate simple aspergilloma from choronic necrotizing pulmonary aspergillosis which need long-term antifungal therapy.There are no specific clinical manifestations in non-neutropenic patients with IPA.Holo sign,air crescent sign or extrapulmonary dissemination are absent in these cases.Voriconazole is the fist-line antifugal treatment.