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目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并侵袭性肺曲霉菌病(IPA)的危险因素及临床特点。方法回顾分析2008年5月至2010年6月浙江大学医学院附属第一医院收治的慢性阻塞性肺疾病急性加重期合并侵袭性肺曲霉菌病患者的临床资料。结果 23例患者中,确诊7例,临床诊断16例。平均年龄(68.3±4.32)岁。其中22例使用广谱抗生素和15例长期使用激素,12例1年内住院>3次,11例年龄>70岁。病灶出现在双上肺占52.1%,双肺多发占21.7%,双下肺占13.0%,位于右中叶和左舌叶共占13.0%;其中5例(21.7%)出现晕征,4例(17.3%)出现“新月”征。结论使用广谱抗生素、长期激素治疗、频繁住院等是慢性阻塞性肺疾病合并肺曲霉菌的危险因素,患者临床表现缺乏特异性,胸部CT表现有一定特征性,结合患者有危险因素及实验室检查,有助于早期诊断和早期治疗,改善患者预后。
Objective To investigate the risk factors and clinical features of AECOPD complicated with invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (AECOPD). Methods The clinical data of patients with invasive pulmonary aspergillosis who underwent acute exacerbation of chronic obstructive pulmonary disease admitted to the First Affiliated Hospital of Medical College of Zhejiang University from May 2008 to June 2010 were retrospectively analyzed. Results Of the 23 patients, 7 were confirmed and 16 were clinically diagnosed. The average age (68.3 ± 4.32) years old. Among them, 22 cases were treated with broad-spectrum antibiotics and 15 cases with long-term use of hormones, 12 cases were hospitalized for more than 3 times in one year and 11 cases were aged> 70 years. The lesions were found in 52.1% of the double upper lungs, 21.7% of the double lungs, 13.0% of the double lower lungs, and 13.0% of the right middle and left lingual lobes, of which 5 (21.7% 17.3%) appeared “Crescent ” sign. Conclusion The use of broad-spectrum antibiotics, long-term hormone therapy, frequent hospitalizations and other chronic obstructive pulmonary disease is a risk factor for pulmonary aspergillosis, the lack of specificity of clinical manifestations of patients with chest CT has some characteristics, combined with patients with risk factors and laboratory Check, help early diagnosis and early treatment, improve patient prognosis.