在资源有限的环境下慢性肺部曲霉菌病患者的临床特征、治疗结果和潜在复发因素：一项回顾性观察研究。

Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study.

机构信息

Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Clinics of Infectious Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

出版信息

Mycopathologia. 2024 Aug 22;189(5):76. doi: 10.1007/s11046-024-00884-9.

DOI:10.1007/s11046-024-00884-9

PMID:39172211

Abstract

OBJECTIVE

To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence.

METHODS

A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded.

RESULTS

Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms.

CONCLUSIONS

Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.

摘要

目的

评估慢性肺曲霉病（CPA）患者的临床特征和治疗结局，并确定疾病复发的危险因素。

方法

本回顾性研究纳入了 43 例 CPA 患者（平均年龄±标准差：61.4±10.5 岁，83.7%为男性）。记录了人口统计学、临床和疾病相关特征、支气管肺泡灌洗液（BAL）GM 试验阳性率、组织病理学诊断、影像学（CT）表现和 CPA 类型、抗真菌治疗、复发率和复发时间等数据。

结果

慢性阻塞性肺疾病（COPD；76.7%）是主要的易患因素，曲霉结节（37.2%）是最常见的 CPA 类型。BAL 样本中 GM 试验阳性率为 89.7%（35/39）。伏立康唑治疗的中位时间为 180 天。14.0%的患者出现 CPA 复发，而并发肺结核后遗症（66.7%比 16.2%，p=0.02）和轻度免疫抑制障碍（100.0%比 51.4%，p=0.032）在复发患者中更为常见。单纯性曲霉瘤患者的复发率为 50.0%（3 例），其他 CPA 类型的复发率为 0.0%至 25.0%。单纯性曲霉瘤的治疗持续时间和复发时间分别为 70-270 天和 1.1-37 个月，而其他 CPA 类型分别为 150-180 天和 30-43.3 个月。