中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

慢性肺曲霉病基础疾病 108 例回顾性分析

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目的 探讨慢性肺曲霉病(CPA)的基础疾病。 方法 回顾分析 2009 年 1 月至 2016 年 12 月原南京军区南京总医院收治的 CPA 患者的病历资料。 结果 总共收治 108 例 CPA 患者,其中 87 例有基础疾病,21 例无基础疾病。务农者比例 66.7%,该比例在无基础疾病组更高(85.7% 比 62.1%)。慢性坏死性肺曲霉病(CNPA)是最多见的类型(72/108,66.7%),在无基础疾病组中的占比高于基础疾病组(85.7% 比 62.1%),在系统性基础疾病组中的占比高于仅肺部基础疾病组(82.8% 比 51.7%)。慢性空洞性肺曲霉病均合并肺部基础疾病(24/108,22.2%)。基础疾病组以陈旧性肺结核(40.2%)、支气管扩张症(39.1%)、慢性阻塞性肺疾病(35.6%)等慢性肺部疾病多见。系统性因素以糖尿病(16.1%)和糖皮质激素使用(13.8%)多见。 结论 患者无论有无基础疾病均可发生 CPA。CNPA 是最常见的类型,其比例在无基础疾病及系统性基础疾病组更高。务农可能是 CPA 的危险因素。慢性肺部疾病是最常见的基础疾病。糖尿病和使用糖皮质激素是最常见的系统性因素。

Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.

关键词: 慢性肺曲霉病; 慢性坏死性肺曲霉病; 肺结核; 支气管扩张症; 慢性阻塞性肺疾病; 糖尿病; 糖皮质激素

Key words: Chronic pulmonary aspergillosis; Chronic necrotizing pulmonary aspergillosis; Pulmonary tuberculosis; Bronchiectasis; Chronic obstructive pulmonary disease; Diabetes; Glucocorticoid

引用本文: 李培, 苏欣, 施毅. 慢性肺曲霉病基础疾病 108 例回顾性分析. 中国呼吸与危重监护杂志, 2018, 17(4): 348-353. doi: 10.7507/1671-6205.201801004 复制

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