摘要
目的探讨无免疫功能缺陷者侵袭性肺曲霉病的诊断及治疗。方法分析2008年1月至2008年12月在中国医科大学附属盛京医院呼吸内科住院的3例无免疫功能缺陷侵袭性肺曲霉病患者的病例资料,同时结合相关文献进行复习。结果既往1例患糖尿病,1例患慢性支气管炎,1例健康。临床共同特点是:病情进展快,发热,进行性呼吸困难,咯灰黄痰,双肺散在干湿罗音。CT表现呈多样性,双肺散在结节影、片影、实变影及多发空洞,洞内有絮状物是其特点,可见树芽征,纵隔多组淋巴结肿大。每例患者痰培养3次均提示烟曲霉菌生长。均用两性霉素B脂质体治疗显示有效,但1例发生急性肾功能不全,1例出现严重的恶心等副作用。结论非免疫缺陷者或健康者也可发生侵袭性肺曲霉病。痰培养2次以上阳性者并结合临床可确定诊断。两性霉素B脂质体治疗侵袭性肺曲霉病有效,因其毒副作用,临床应用受到一定限制。
【Objective】To study the diagnosis and treatment of invasive pulmonary aspergillosis （IPA） in patients without immunodeficiency【.Methods】Clinical characteristics of IPA in 3 patients without immunodeficiency were studied, and related literatures were reviewed. 【Results】Two of the patients had underlying diseases, which were diabetes mellitus and chronic bronchitis respectively. Their clinical characteristics were as follows： quick progress, fever, progressive dyspnea, grayish-yellow sputum production. scattered rales and wheezes in both lungs. The find- ings of CT were diversiform which included shadows of nodules, patchy and consolidation, multiple cavities with floccules, and tree-in-bud sign. Lymphadenectasis could be seen in mediastinum. Aspergillus fumigatus was found in the sputum culture for three times in each patient. The three patients were all treated with liposomal amphotericin B and the treatment was effective. But 1 patient developed acute renal failure, and another patient had serious nausea. 【Conclusion】IPA can occur in persons without immunodeficiency. With the clinical characteristics and positive sputum culture over twice, IPA can be proved. Liposomal amphotericin B is an effective medicine in the treatment of IPA, but its clinical application is limited by its side effects.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2010年第4期612-615,618,共5页
China Journal of Modern Medicine
关键词
肺疾病
曲霉菌病
诊断
pulmonary disease
aspergillosis
diagnosis
