Zhu Lan-yan, Xu Yu-jie, Chen Ping
Department of Respiratory Medicine. The Second Xiangya Hospital Affiliated Central South University, Changsha 410011, China.
Zhonghua Nei Ke Za Zhi. 2012 Oct;51(10):759-62.
To study the clinical features of invasive pulmonary aspergillosis (IPA) with chronic obstructive pulmonary diseases (COPD), so as to provide evidence for early diagnosis and treatment.
A retrospective analysis was made upon clinical data, diagnosis, treatment and prognosis of 53 patients with IPA and COPD admitted between January 2005 and February 2011 collected in a respiratory unit of the Second Xiangya Hospital Affiliated Central South University.
There were 53 cases of diagnosed as IPA with COPD, with history of using broad-spectrum antibiotics. And there were 43 cases using steroids more than 2 weeks, 51 with obvious breathlessness, and 20 with fever. Early stage didn't present characteristical changes on CT scan. However, after disease progression, 32 cases had maculas shadows and nonspecific consolidations in bilateral lung, 14 with solitary or multiple nodules, 4 with solitary or multiple air crescent sign, and 2 with halo sign. Four patients of COPD with IPA underwent bronchoscopy examination. In fungi pathogeny, sputum positive rate and galactomannan positive rate were 56.6% and 52.8%, respectively. A total of 53 cases received antifungal treatment. Among 37 cases which underwent mechanical ventilation, 24 received noninvasive ventilation and 13 received invasive ventilation. There were 33 cases which were improved and cured, and 20 cases which had no relief after half-a-month treatment or withdrew treatment. Among them, 13 cases died because of multiple-organ failure (5/15) or acute renal failure (8/15).
Early suspected diagnosis, timely examination in allusion to IPA, actively searching for etiological and imaging evidences, early established diagnosis and antifungal treatment would improve prognosis of patients with COPD combined IPA who have history of high doses of corticosteroids, obvious breathlessness and non-response to antibiotics.
研究慢性阻塞性肺疾病（COPD）合并侵袭性肺曲霉病（IPA）的临床特点，为早期诊断和治疗提供依据。
回顾性分析2005年1月至2011年2月中南大学湘雅二医院呼吸科收治的53例COPD合并IPA患者的临床资料、诊断、治疗及预后情况。
53例确诊为COPD合并IPA患者，均有使用广谱抗生素史。其中43例使用糖皮质激素超过2周，51例有明显气促，20例有发热。早期胸部CT扫描无特征性改变。病情进展后，32例双肺出现斑片状阴影及非特异性实变影，14例出现孤立或多发结节影，4例出现孤立或多发空气新月征，2例出现晕征。4例COPD合并IPA患者行支气管镜检查。真菌病原学检查中，痰培养阳性率为56.6%，半乳甘露聚糖抗原检测阳性率为52.8%。53例患者均接受抗真菌治疗。37例行机械通气患者中，24例接受无创通气，13例接受有创通气。33例病情改善或治愈，20例经半月治疗病情无缓解或放弃治疗。其中13例因多器官功能衰竭（5/15）或急性肾衰竭（8/15）死亡。
对于有大剂量糖皮质激素使用史、明显气促且抗生素治疗无效的COPD合并IPA患者，早期疑似诊断，针对IPA及时检查，积极寻找病原学及影像学证据，尽早明确诊断并进行抗真菌治疗，可改善患者预后。
