间质性肺疾病患者侵袭性肺曲霉病的临床特征及危险因素
Clinical features and risk factors of invasive pulmonary aspergillosis in interstitial lung disease patients.
作者信息
Liu Yin, Jiang Hanyi, Zhao Tingting, Cao Min, He Jian, Qi Rongfeng, Xiao Yonglong, Su Xin
机构信息
Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
Department of Nuclear Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
出版信息
BMC Pulm Med. 2024 Dec 4;24(1):602. doi: 10.1186/s12890-024-03430-x.
BACKGROUND
The prevalence of invasive pulmonary aspergillosis (IPA) among patients with interstitial lung disease (ILD) is steadily increasing, leading to high mortality. The purpose of this study is to analyze the clinical features and risk factors of IPA in patients with ILD.
METHODS
353 hospitalized ILD patients admitted in Nanjing Drum Tower Hospital from March 2023 and April 2024 were enrolled. The enrolled patients were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups.
RESULTS
Among 353 patients with ILD, 58 who suffered from IPA were identified. Among them, 2 (3.4%) episodes of proven IPA and 56 (96.6%) of probable IPA were diagnosed. The median age was 68.4 ± 8.6 years, and 35 patients were men. The forms of ILD included idiopathic pulmonary fibrosis (n = 21), interstitial pneumonia with autoimmune features (n = 13), rheumatoid arthritis related interstitial pneumonia (n = 11) and Sjögren's syndrome (n = 4). The clinical features of IPA in ILD were cough (100.0%), dyspnea (93.1%) and fever (55.2%). Chest CT images showed reticulation (87.9%), traction bronchiectasis (84.5%), GGO (77.6%), honeycombing (69.0%), consolidation (44.8%) and pleural effusion (24.1%). The incidence of honeycombing and consolidation were higher in ILD patients with IPA compared to control group (P < 0.05). The main pathogens were A. fumigatus (50.0%) and A. flavus (29.3%). Following the diagnosis of IPA, all patients were treated with antifungal drugs. The overall survival rate after 90 days was 74.1%. Multivariate conditional Logistic regression analysis showed that lymphopenia (OR = 2.745, 95% CI 1.344-5.607) and honeycombing (OR = 2.915, 95% CI 1.429-5.949) were the risk factors of ILD with IPA (P < 0.05).
CONCLUSION
IPA is one of the major complications of ILD and its prognosis is poor. Lymphopenia and honeycombing increased the risk of IPA in ILD patients.
背景
间质性肺疾病（ILD）患者中侵袭性肺曲霉病（IPA）的患病率正在稳步上升，导致高死亡率。本研究的目的是分析ILD患者中IPA的临床特征和危险因素。
方法
纳入2023年3月至2024年4月在南京鼓楼医院住院的353例ILD患者。将纳入的患者分为IPA组（确诊和拟诊IPA）和非IPA组，比较两组的临床特征和预后。
结果
在353例ILD患者中，确诊为IPA的有58例。其中，确诊IPA 2例（3.4%），拟诊IPA 56例（96.6%）。中位年龄为68.4±8.6岁，男性35例。ILD的类型包括特发性肺纤维化（n = 21）、具有自身免疫特征的间质性肺炎（n = 13）、类风湿关节炎相关间质性肺炎（n = 11）和干燥综合征（n = 4）。ILD患者中IPA的临床特征为咳嗽（100.0%）、呼吸困难（93.1%）和发热（55.2%）。胸部CT图像显示网状影（87.9%）、牵拉性支气管扩张（84.5%）、磨玻璃影（GGO，77.6%）、蜂窝状改变（69.0%）、实变（44.8%）和胸腔积液（24.1%）。与对照组相比，ILD合并IPA患者的蜂窝状改变和实变发生率更高（P < 0.05）。主要病原体为烟曲霉（50.0%）和黄曲霉（29.3%）。确诊IPA后，所有患者均接受抗真菌药物治疗。90天后的总生存率为74.1%。多因素条件Logistic回归分析显示，淋巴细胞减少（OR = 2.745，95%CI 1.344 - 5.607）和蜂窝状改变（OR = 2.915，95%CI 1.429 - 5.949）是ILD合并IPA的危险因素（P < 0.05）。
结论
IPA是ILD的主要并发症之一，其预后较差。淋巴细胞减少和蜂窝状改变增加了ILD患者发生IPA的风险。
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