| 邰艳秒,蒋晨成,王建,等.无基础疾病肺曲霉病病人临床特征的调查分析[J].安徽医药,2023,27(4):698-701. |
| 无基础疾病肺曲霉病病人临床特征的调查分析 |
| Investigation and analysis of the clinical characteristics of pulmonary aspergillosis patients without underlying diseases |
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| DOI：10.3969/j.issn.1009-6469.2023.04.014 |
| 中文关键词: 肺曲霉菌感染 体征和症状 合并症 基础疾病 影像学表现 |
| 英文关键词: Pulmonary aspergillus infection Signs and symptoms Comorbidities Underlying diseases Imaging manifestations |
| 基金项目:河北省卫生健康委员会( 20200264) |
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| 中文摘要: |
| 目的调查分析无基础疾病的肺曲霉病( PA)病人临床特征，从而为临床诊治提供参考依据。方法选取保定市第二中心医院 2012年 1月至 2021年 10月收治的 220例 PA病人。将其按照是否合并基础疾病分作无基础疾病组 43例以及有基础疾病组 177例。回顾性分析两组临床资料，分析无基础疾病 PA病人临床症状表现、实验室检查结果、影像学检查情况以及转归。结果无基础疾病组务农者人数占比为 81.40%，高于有基础疾病组的 57.63%(P<0.05)；两组性别、年龄、体质量指数(BMI)以及受教育年限对比均不明显(均 P>0.05)。侵袭性 PA病人临床症状出现时间相较于慢性坏死性 PA、寄生型 PA明显更短，且寄生型 PA临床症状出现时间相较于慢性坏死性 PA更短；侵袭性 PA临床症状表现包括发热、咳嗽、咯血、胸痛以及咯痰等，占比 68.18%，慢性坏死性 PA临床症状表现包括咳嗽、咯血以及咯痰，占比 83.33%，寄生型 PA均出现咯血症状，且有 1例伴有咳嗽。无基础疾病 PA病人 C反应蛋白( CRP)升高、降钙素原( PCT)升高、血沉( ESR)升高人数占比分别为 32.56%、27.91%、34.88%，而 G试验、 GM试验指标升高人数占比为 4.65%、2.33%。侵袭性 PA病人单肺或双肺炎症人数占比 68.18%，其中支气管充气征以及胸膜下炎症各有 1例，占比为 4.55%；慢性坏死性 PA存在单肺或双肺结节伴空洞形成表现人数占比66.67%；寄生型 PA病人均有空洞中致密团块状阴影表现。无基础疾病 PA病人保守治疗 36例，住院时间( 18.95±4.09)d，症状、影像学较治疗前好转出院；手术治疗 7例，住院时间( 20.31±4.21)d，症状、影像学较治疗前好转出院。结论无基础疾病 PA病人务农人数占比较高，其临床特征不典型，诊断过程中应及时选择合适的诊断方式，继而为早期治疗提供指导作用，达到改善转归的目的。 |
| 英文摘要: |
| Objective To investigate and analyze the clinical characteristics of patients with pulmonary aspergillosis (PA) withoutunderlying disease to provide a reference for clinical diagnosis and treatment.Methods A total of 220 patients with PA admitted toBaoding No. 2 Central Hospital from January 2012 to October 2021 were selected. According to the combination of underlying diseasesor not, the patients were divided into 43 cases in the group without underlying diseases and 177 cases in the group with underlying diseases. The clinical data of the two groups were retrospectively analyzed, and the clinical symptoms, laboratory examination results, imaging examinations and outcomes of PA patients without underlying diseases were analyzed.Results The proportion of farmers in thegroup without underlying diseases was 81.40%, which was higher than that of the group with underlying diseases (57.63%) (P < 0.05). There were no significant differences in sex, age, BMI or years of education between the two groups (P> 0.05). The time of clinical symptoms in patients with invasive PA was significantly shorter than that in patients with chronic necrotizing PA and parasitic PA, andthe time of clinical symptoms in patients with parasitic PA was shorter than that in patients with chronic necrotizing PA. The clinicalsymptoms of invasive PA included fever, cough, hemoptysis, chest pain and phlegm, accounting for 68.18%, while the clinical symptoms of chronic necrotizing PA included cough, hemoptysis and phlegm, accounting for 83.33%. All parasitic PA showed hemoptysisand one case was accompanied by cough. In PA patients without underlying diseases, the percentages of patients with elevated C-reactive protein (CRP), elevated calcitoninogen (PCT), and elevated sedimentation rate (ESR) were 32.56%, 27.91% and 34.88%, respectively, while the proportions of patients with elevated G test and GM test indicators were 4.65% and 2.33%, respectively. The number ofinvasive PA patients with single lung or both lungs accounted for 68.18%, including one case each of bronchial inflation and subpleuralinflammation, accounting for 4.55%. The proportion of chronic necrotizing PA patients with single or double lung nodules with cavityformation in was 66.67%. All patients with parasitic PA showed dense mass-like shadows in cavities. There were 36 patients with PAwithout underlying diseases who were treated conservatively, hospitalized for 18.95±4.09 d, and discharged with better symptoms andimaging than before treatment, and 7 patients who were treated surgically, hospitalized for 20.31±4.21 d, and discharged with bettersymptoms and imaging than before treatment.Conclusion The number of PA patients without underlying diseases who are farmers isrelatively high, and their clinical characteristics are atypical. The appropriate diagnostic methods should be selected in a timely mannerin the diagnosis process and then provide guidance for early treatment to achieve improved regression. |
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