Clinical Analysis Of Invasive Pulmonary Aspergillosis In COPD Patients

Objective:To deeper the understanding of this disease and improve the diagnostic level by analyzing the clinical manifestation and imaging feature of invasive pulonary aspergillosis in chronic obstructive pulmonary disease patients.Method:We reviewd the clinical date of48admissions who were treated in1st Affiliated Hospital,College of Medicine,Zhejiang University from Jan2012to Dec2013. We analyse the differences between COPD and non-COPD patients.Clinical manifestation, laboratory examination,imaging feature,treatment and prognosis are all included.ResultsAmong the48invasive pulmonary aspergillosis patients,16patients are COPD patients. The two groups have similar clinical manifestation,such as cough,sputum, fever, chest tightness, dyspnea,hemoptysis.In COPD groups,87.50%(14/16) patients CRP increased when new symptoms occour,62.50%(10/16) patients have higher WBC count.In non-COPD group,78.13%(25/32) patients initial CRP rose,28.13%(9/32) patients existed leukocytosis,8patients (25%) are Leukopenia and neutropenia (all suffering from hematological diseases). Imaging signs such as nodules, consolidation-or-mass, ground glass opacity, cavity, terminal airway lesions,halo sign, air crescent sign can be found in both groups.Cavity is the most common sign in the COPD group (62.5%),followed by bronchiectasis in small airway (56.52%) and micronodules (56.52%).In the other group, the first two sign are respectively macronodules(56.25%)and micronodules(46.88%).Airway-invasive form is obviously more common in COPD patients (68.75%) than non-COPD patients (34.38%).Mass is not so common in COPD patients with IPA (6.25%) compared with the other group(34.38%). While the signs of terminal airway lesions,including bronchiectasis and tree-in-bud,are more frequent.Conclusion:When combined with IPA,the COPD patients have similar clinical manifestation to non-COPD patients.The maily manifestation includes fever, cough,sputum, chest tightness, dyspnea,hemoptysis.In some patients CRP and WBC can rise.There is no statistical difference between the two groups. Invasive pulmonary aspergillosis in COPD patients are more inclined to airway-invasive. The signs of terminal airway lesions and cavity in small objective are more common in these patients.Mass occours less frequently than other patients.