Analysis Of Clinical Characteristics And Exploration Of Risk Factors Of Chronic Obstructive Pulmonary Disease Combined With Invasive Pulmonary Aspergillosis

Objective:To investigate the clinical features of chronic obstructive pulmonary disease secondary to invasive pulmonary aspergillosis and the potential risk factors.This will improve the awareness and prevention of the disease among clinical worker Methods:Data related to 45 patients with COPD combined with IPA were collected,and this group was the COPD-IPA group.In addition,45 patients who were hospitalized for COPD but not combined with IPA during the same period were randomly selected as the control group(COPD control group).Clinical data of all patients were extracted from medical records,and data on underlying comorbidities,respiratory symptoms and signs,laboratory indices,imaging manifestations,relevant pathogenic findings,relevant treatment measures and regression were analyzed in the COPD-IPA group and COPD control group,while relevant risk factors were included in logistic regression analysis to explore potential risk factors for secondary IPA in COPD.Results:1、On univariate analysis,the COPD-IPA group was found to be statistically different from the COPD control group in terms of length of stay ≥2 weeks,hypoproteinemia,systemic hormone use,use of antibiotics for ≥2 weeks,use of ≥3antibiotics,and admission to the ICU(P < 0.05).2、A multifactorial logistic regression analysis revealed that systemic hormone use,use of antibiotics for ≥2 weeks,use of ≥3 antibiotics,and hypoproteinemia were risk factors for secondary IPA in COPD patients(P<0.05).3、The most common complaint in the COPD-IPA group was chest tightness(40cases,88.9%),followed by cough and sputum,fever,and hemoptysis,and chest pain was less common;in addition,fever,hemoptysis,malaise,and weight loss were more common in the COPD-IPA group,and the differences were statistically significant(P <0.05).4、Compared with the COPD control group,WBC,NE,NE%,CRP,and LDH were elevated in the COPD-IPA group,while ALB and Hb showed a decrease,and the differences were statistically significant((P < 0.05)).5、Imaging in the COPD-IPA group was dominated by signs of airway invasion,such as manifestations of nodules,thickened or narrowed tracheal walls,pleural effusions,and tree-bud signs.6、Aspergillus pathogenesis in COPD combined with IPA was dominated by Aspergillus fumigatus(23 cases,51.1%),followed by Aspergillus flavus,Aspergillus niger,Aspergillus oryzae,and Aspergillus terreus.7、The positive rates of alveolar lavage fluid culture,and alveolar lavage fluid macrogenome second-generation sequencing(BALF-mNGS)were higher than those of respiratory tract culture.Conlusion:1、When COPD patients have hypoalbuminemia,systemic hormone use,antibiotic use ≥ 3,antibiotic use for ≥ 2 weeks and other related clinical factors,they are more likely to develop IPA.2、The clinical manifestations of COPD combined with IPA are cough and sputum,chest tightness,hemoptysis and fever,among which the occurrence of IPA should be highly alerted when combined with hemoptysis.3、Non-specific signs of airway invasion predominate on CT chest imaging in COPD combined with IPA.