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目的提高对非粒细胞缺乏患者侵袭性气道曲霉病的认识及诊疗水平。方法回顾性分析19例非粒细胞缺乏患者侵袭性气道曲霉病的危险因素,临床特征,影像学,支气管镜下表现,治疗及预后资料。结果 19例患者男性13例(68%),女性6例(32%),年龄33~76岁、平均(57.32±11.69)岁。既往患慢性阻塞性肺疾病4例(21%),糖尿病4例(21%),肺癌3例(16%),高血压病3例(16%),陈旧性肺结核病2例(11%),支气管扩张2例(11%),肺血管炎1例(5%),间质性肺病1例(5%);其中2例患者有3种以上基础疾病,7例有2种基础疾病。常见的临床症状为咳嗽,气急(100%),发热(74%);影像学改变早期主要为沿气道分布的结节,渗出,12例患者入院后胸部CT显示病灶明显进展;支气管镜下改变以混合型为主;首选治疗药物为伏立康唑针;总疗程均大于6周,最长22周;死亡率为16%,其中1例因经济原因治疗4周后自行停药,8周后再次因为肺部出现新病灶病情进展再次入院。结论侵袭性气道曲霉病是侵袭性肺曲霉病的一种少见类型,在非粒细胞缺乏的患者身上常常漏诊、误诊,提高对本病的认识,及早进行支气管镜检查,早期诊断及全身治疗可以减少患者的死亡率。
Objective To improve the understanding and diagnosis and treatment of invasive gas aspergillosis in non-granulocytic patients. Methods Retrospective analysis of 19 non-granulocytic patients with invasive aspergillosis risk factors, clinical features, imaging, bronchoscopic performance, treatment and prognostic data. Results Of the 19 patients, 13 (68%) were males and 6 females (32%), aged 33-76 years (mean, 57.32 ± 11.69 years). 4 (21%) had previous COPD, 4 (21%) had diabetes, 3 (16%) had lung cancer, 3 (16%) had Hypertension and 2 (11% , 2 cases of bronchiectasis (11%), 1 case of pulmonary vasculitis (5%) and 1 case of interstitial lung disease (5%). Of these, 2 had 3 or more underlying diseases and 7 had 2 underlying diseases. Common clinical symptoms of cough, shortness of breath (100%), fever (74%); early imaging changes mainly along the airways nodules, exudation, 12 patients after admission chest CT showed significant improvement in the lesions; bronchoscopy The main course of treatment was voriconazole needles. The total duration of treatment was more than 6 weeks and the maximum was 22 weeks. The mortality rate was 16%. One of the patients was stopped for medical reasons after 4 weeks of treatment. After 8 weeks Again because of the emergence of new lesions in the lungs progress again hospitalized. Conclusions Invasive airways aspergillosis is a rare type of invasive pulmonary aspergillosis and often misdiagnosis, misdiagnosis, increased awareness of the disease in patients with non-granulocytic deficiency, early bronchoscopy, early diagnosis and systemic treatment Can reduce the patient’s mortality rate.