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慢性阻塞性肺疾病患者的侵袭性肺曲霉病:一例报告并文献复习

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case report and review of the literature.

作者信息

Bao Zhiyao, Chen Hong, Zhou Min, Shi Guochao, Li Qingyun, Wan Huanying

机构信息

Department of Respiratory Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

出版信息

Oncotarget. 2017 Jun 6;8(23):38069-38074. doi: 10.18632/oncotarget.16971.

Abstract

Invasive pulmonary aspergillosis (IPA) is an infection that often occurs in immunocompromised patients and has a high mortality rate. In recent years, the reported incidence of IPA in the context of chronic obstructive pulmonary disease (COPD) has seemingly increased. The combination of factors such as long-term corticosteroid use, increasing rate of bacterial exacerbations over time, lung immune imbalance, and malnutrition are responsible for the emergence of IPA in COPD patients. A diagnosis of IPA in COPD patients is difficult to make, which explains the delay in antifungal therapy and the high mortality rate. The purpose of this study is to increase the recognition and improve the outcomes associated with this situation through the description of our case. In patients in which IPA is suspected, comprehensive analysis of their clinical manifestations, imaging, microbiology and serological examination results are effective means of increasing the rate of reliable diagnosis. If the patient's condition permits, a pathological specimen should be obtained as soon as possible.

摘要

侵袭性肺曲霉病(IPA)是一种常发生于免疫功能低下患者的感染性疾病,死亡率很高。近年来,慢性阻塞性肺疾病(COPD)患者中IPA的报告发病率似乎有所上升。长期使用皮质类固醇、细菌感染急性加重率随时间增加、肺部免疫失衡和营养不良等多种因素共同导致了COPD患者中IPA的出现。COPD患者的IPA诊断困难,这也解释了抗真菌治疗的延迟和高死亡率。本研究的目的是通过描述我们的病例,提高对这种情况的认识并改善相关治疗结果。对于疑似IPA的患者,综合分析其临床表现、影像学、微生物学和血清学检查结果是提高可靠诊断率的有效手段。如果患者情况允许,应尽快获取病理标本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a449/5513717/cc714a317766/oncotarget-08-38069-g001.jpg

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