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目的探讨肝衰竭并发肺曲霉菌病的易感因素、临床特点、诊断及治疗。方法回顾性分析2006年12月至2008年10月苏州大学附属第一医院收治的10例肝衰竭并发侵袭性肺曲霉菌病(IPA)患者的临床特点及诊治经过,统计分析相关资料。结果肝衰竭并发IPA患者与自身免疫功能低下、广谱抗生素及激素的应用、侵入性诊疗操作等因素相关;临床特征不典型,可表现为原发疾病的加重,不同程度发热、咳嗽、咳痰、胸闷,听诊肺部湿啰音等,但亦有部分患者可无任何特异性症状及体征;对于诊断为IPA患者,及早予伏立康唑等药物治疗,治愈率达70%。结论肝衰竭并发IPA临床特征不典型,根据患者病情变化,及时行GM试验、胸部CT检查是早期诊断的依据,尽早予伏立康唑等抗真菌药物进行抢先治疗是提高救治成功率的关键。
Objective To investigate the susceptibility factors, clinical features, diagnosis and treatment of pulmonary failure with pulmonary aspergillosis. Methods The clinical features, diagnosis, treatment and statistical analysis of 10 patients with liver failure complicated with pulmonary aspergillosis (IPA) admitted to the First Affiliated Hospital of Soochow University from December 2006 to October 2008 were retrospectively analyzed. Results The patients with liver failure complicated with IPA were associated with autoimmune dysfunction, broad-spectrum antibiotics and hormones, invasive diagnosis and treatment, and other factors. The clinical features were not typical, which were manifested as exacerbation of primary disease, fever, cough and expectoration , Chest tightness, auscultation of lung wet auscultation, etc., but some patients may have no specific symptoms and signs; for the diagnosis of IPA patients, as early as voriconazole and other drug treatment, the cure rate was 70%. Conclusions The clinical features of IPA in patients with liver failure are not typical. According to the patients’ condition, the GM test and chest CT examination are the basis of early diagnosis. Early treatment with antifungal agents such as voriconazole is the key to improve the success rate of treatment.