Clinical Analysis Of Pulmonary Aspergillosis In 45 Cases

【Objective】The aim of this study was to elevate the level of clinical diagnosis and treatment and improve prognosis about pulmonary invasive pulmonary aspergillosis (IPA) and saprophytic pulmonary aspergillosis.In order to achieve this objective,we assessed and analyzed their host factors,diagnostic methods(CT and GM test ad.), therapeutic regimens and risk factors influencing mortality about pulmonary aspergillosis.【Methods】We conducted a retrospective study on the patients with pulmonary aspergillosis were diagnosed from Nov.2002 to Mar.2008 in Zhongshang Hospital. (1) Schedule tables were made to record the detail information of each patient with pulmonary aspergillosis to investigate the demography of the patients compromising the study,evidences of diagnosis,including the host factors,clinical characters,CT, microbiological examination,GM test and pathological examination,therapeutic regimens,prognostic evaluation and the risk factors influencing mortality.(2) Continuous variables were expressed as the mean for those with a normal distribution,and as the median.Discrete variables were expressed as percentages. Student's unpaired t-test was used to compare continuous variables,the Mann-Whitney U-test to compare continuous variables with non-normal distribution, and the chi-squared or Fisher exact test was used to compare proportions.All statistical tests were two-tailed and the threshold of statistical significance was p＜0.05.Odds ratios(ORs) were calculated for variables with statistically significant differences between patients with or without LI.Binary logistic regression was applied individually to each variable to obtain the OR in the univariate analysis.【Results】(1)A total of 54 patients were reviewed.35(64.8%) patients were male and 19(35.2%) were female.Their ages range from 23 to 81 with a mean of 51. 36(66.7%) were IPA,The cases of proven or probable IPA were increasing from 2004 to 2007.80%(12/15) of Aspergillus recovered from patients with IPA was A.Fumigatus,which is the most frequently species.(2) In 36 cases of IPA,4(11.1%) had host factor,10(27.8%) only had chronic disease.The signs of CT in 28 cases: 22(78.6%) had nodule,14(50%) had mass(Φ≥3cm),9(32.1%) had wedge-shaped infiltrate,9(32.1%) had halo sign,3(10.7%) had air crescent sign,22(78.6%) had cavity.Positive rate of sputum culture,BALF culture,GM test(≥0.5) and pathological examination was 52.8%(19/36),55.6%(5/9),80%(16/20) and 88.3%(10/12) respectively.10(27.8%) was proven and 26(72.2%) was probable.18(50%) was hospital acquired infection.Misdiagnosis rate of initial diagnosis was 63.9%(23/36). Effective rate of primary treatment was 48.6%(17/35).Case-fatality rate was 30.6%(11/36) in total.Risk factors influencing mortality were analyzed,and we could discover elder-age,organ transplant recipient,COPD and positive sputum cultures have statistical significance(p＜0.05).(3) In 18 cases of saprophytic pulmonary aspergillosis,which was proven by histopathological examination of lung tissue, 6(33.3%) had underlying pulmonary disease.15(88.3%) existed hemoptysis.9(50%) saw aspergilloma and air crescent sign on chest CT scan.4 case did GM test and all of them were positive.Misdiagnosis rate of initial diagnosis was 83.3%(15/18),while 11(61.1%) was correct diagnosis before operation.11 case were followed up afer operation and cure rate was 90.9%(10/11).1 case recurred and had complication after operation.【Conclusion】(1) IPA and saprophytic pulmonary aspergillosis had differences in host factors,clinical characters,CT signs,therapeutic regimens and prognosis(2) The cases of proven or probable IPA were increasing from 2004 to 2007.A.Fumigatus was the most frequently species.Chronic pulmonary disease(COPD,pulmonary tuberculosis,bronchiectasis),which were not the classic host factors,were noteworthy. (3) CT signs:irregular nodus or mass,followed by cavity,distributed in pulmones was frequent,while wedge-shaped infiltrate,halo sign and air crescent sign could be observed sometimes.Misdiagnosis rate of initial diagnosis was 63.9%,and final diagnosis was difficult.(4) Effective rate of primary treatment was 48.6%, Case-fatality rate was 30.6%.Elder-age,Organ transplant recipient,COPD and positive sputum cultures were risk factors influencing mortality.(5) Only 33.3%of 18 Saprophytic pulmonary aspergillosis had host factor,which usually was cavitary lung disease,such as cavitary tuberculosis.(6) Emptysis(88.3%) was cardinal symptom. CT signs:nodus or mass ofen distributed below membrana pleuralis,and half found aspergilloma and air crescent sign.Only 11(61.1%) was correct diagnosis before operation.(5) Surgical resection was a definitive treatment in patients with emptysis, cure rate of which was 90.9%(10/11).