俄罗斯的新型冠状病毒肺炎相关肺曲霉病
COVID-19-Associated Pulmonary Aspergillosis in Russia.
作者信息
Shadrivova Olga, Gusev Denis, Vashukova Maria, Lobzin Dmitriy, Gusarov Vitaliy, Zamyatin Mikhail, Zavrazhnov Anatoliy, Mitichkin Mikhail, Borzova Yulia, Kozlova Olga, Desyatik Ekaterina, Burygina Ekaterina, Ignatyeva Svetlana, Oganesyan Ellina, Vasilyeva Natalya, Klimko Nikolay
机构信息
North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia.
Botkin's Hospital, 195067 Saint-Petersburg, Russia.
出版信息
J Fungi (Basel). 2021 Dec 10;7(12):1059. doi: 10.3390/jof7121059.
We studied the risk factors, etiology, clinical features and the effectiveness of therapy of COVID-19-associated pulmonary aspergillosis (CAPA) in adult patients. In this retrospective study, we included 45 patients with proven (7%) and probable (93%) CAPA. The ECMM/ISHAM, 2020 criteria were used to diagnose CAPA. A case-control study was conducted to study the risk factors of CAPA; the control group included 90 adult COVID-19 patients without IA. In CAPA patients, the main underlying diseases were diabetes mellitus (33%), and hematological and oncological diseases (31%). The probability of CAPA developing significantly increased with lymphocytopenia >10 days (OR = 8.156 (3.056-21.771), = 0.001), decompensated diabetes mellitus (29% vs. 7%, (OR = 5.688 (1.991-16.246), = 0.001)), use of glucocorticosteroids (GCS) in prednisolone-equivalent dose > 60 mg/day (OR = 4.493 (1.896-10.647), = 0.001) and monoclonal antibodies to IL-1ß and IL-6 (OR = 2.880 (1.272-6.518), = 0.01). The main area of localization of CAPA was the lungs (100%). The clinical features of CAPA were fever (98% vs. 85%, = 0.007), cough (89% vs. 72%, = 0.002) and hemoptysis (36% vs. 3%, = 0.0001). Overall, 71% of patients were in intensive care units (ICU) (median-15.5 (5-60) days), mechanical ventilation was used in 52% of cases, and acute respiratory distress syndrome (ARDS) occurred at a rate of 31%. The lung CT scan features of CAPA were bilateral (93%) lung tissue consolidation (89% vs. 59%, = 0.004) and destruction (47% vs. 1%, = 0.00001), and hydrothorax (26% vs. 11%, = 0.03). The main pathogens were (44%) and (31%). The overall survival rate after 12 weeks was 47.2%.
我们研究了成年患者中与新型冠状病毒肺炎（COVID-19）相关的肺曲霉病（CAPA）的危险因素、病因、临床特征及治疗效果。在这项回顾性研究中，我们纳入了45例确诊（7%）和很可能（93%）患有CAPA的患者。采用2020年欧洲医学真菌学联合会/国际人类和动物真菌病学会（ECMM/ISHAM）标准诊断CAPA。进行了一项病例对照研究以探讨CAPA的危险因素；对照组包括90例无侵袭性肺曲霉病（IA）的成年COVID-19患者。在CAPA患者中，主要基础疾病为糖尿病（33%）以及血液系统和肿瘤性疾病（31%）。淋巴细胞减少>10天（比值比（OR）=8.156（3.056 - 21.771），P = 0.001）、失代偿性糖尿病（29%对7%，（OR = 5.688（1.991 - 16.246），P = 0.001））、使用泼尼松等效剂量>60 mg/天的糖皮质激素（GCS）（OR = 4.493（1.896 - 10.647），P = 0.001）以及白细胞介素-1β和白细胞介素-6单克隆抗体（OR = 2.880（1.272 - 6.518），P = 0.01）时，CAPA发生的可能性显著增加。CAPA的主要定位部位是肺部（100%）。CAPA的临床特征为发热（98%对85%，P = 0.007）、咳嗽（89%对72%，P = 0.002）和咯血（36%对3%，P = 0.0001）。总体而言，71%的患者入住重症监护病房（ICU）（中位数为15.5（5 - 60）天），52%的病例使用了机械通气，急性呼吸窘迫综合征（ARDS）发生率为31%。CAPA的肺部CT扫描特征为双侧（93%）肺组织实变（89%对59%，P = 0.004）和破坏（47%对1%，P = 0.00001），以及胸腔积液（26%对11%，P = 0.03）。主要病原体为[此处原文未明确具体病原体]（44%）和[此处原文未明确具体病原体]（31%）。12周后的总体生存率为47.2%。
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