| Objective:To make retrospective analysis on the clinical manifestation,imaging characteristics,laboratory examination,diagnosis method and treatment and prognosis of 28 cases of invasive pulmonary aspergillosis based on literature,and to investigate the clinical data of invasive pulmonary aspergillosis and summarize its characteristics,so as to improve physicians' clinical diagnosis and treatment of invasive pulmonary aspergillosis.Methods:Data of 28 discharged patients confirmed or clinically diagnosed as invasive pulmonary aspergillosis from January 2008 to December 2017 in the first hospital of Shanxi Medical University and Taiyuan Tuberculosis Hospital were collected to make retrospective analysis on the clinical manifestation,imaging characteristics,laboratory examination,diagnosis method and treatment and prognosis.Results:(1)28 patients with invasive pulmonary aspergillosis were selected,in which 15 cases were clinically diagnosed as invasive pulmonary aspergillosis and 13 cases were diagnosed.There were 22 males(78.57%)and 6 females(21.43%),aged 25~81 years,with an average age of 56.18 + 15.30.The average age of males was 55.53 + 17.52,and that of females was 57.18 ± 11.97,P > 0.05(t=-0.273,P=0.787 > 0.05).The age of high incidence was 40-80(89.29%).From January 2008 to December 2017,the cases of clinical diagnosis and diagnosis were 0,0,2,2,1,3,4,6,4 and 6,showing an obvious rising trend.(2)Among the 28 cases of invasive pulmonary aspergillosis,basic diseaseswere all combined,including 13 cases of pulmonary tuberculosis,5 cases of chronic obstructive pulmonary disease,3 cases of type 2 diabetes,1 case of renal transplantation,1 case of severe pneumonia,4 cases of AIDS,and 1 case of systemic lupus erythematosus.(3)The clinical symptoms of the patients were not specific,mainly including cough,expectoration,breath shortness and fever.The sputum was mainly yellow phlegm or white phlegm.The temperature was 38-39.6 C,belonging to irregular fever.(4)Lesions of invasive pulmonary aspergillosis were mainly in multiple,and they were characterized with nodules.(5)There were 20 cases of invasive pulmonary aspergillosis patients showing positive in GM test,with the positive rate of 71.43%;there were 22 cases showing positive in(1,3)-?-D glucan examination,with the positive rate of 78.57%;there were 13 cases showing positive in sputum specimens culturing,with the positive rate of 46.43%;there were 15 cases showing positive in BALF,with the positive rate of 53.57%;there were 3 cases showing positive in TBLB,with the positive rate of 10.71%;there were 10 cases showing positive in percutaneous lung puncture,with the positive rate of 35.71%.(6)28 cases of patients with invasive pulmonary aspergillosis all received antifungal therapy.Due to the poor effect of fluconazole in empiric treatment,4 patients were improved after changing voriconazole followed by drug sensitivity results return.10 patients were treated with single standardized use of voriconazole(the first dose--6mg/kg,intravenous injection,two times/day;later changed to 4mg/kg,two times/day;2 weeks after changed to oral administration of200 mg,two times/day),and 3 of them died.The condition of 1 patient was improved after being treated with caspofungin alone(intravenous injection of 70 mg for the first time,maintaining capacity of 50mg/d,once/day).5 patients were treated with itraconazole alone(200mg,two times/day,4 days later changed to 200 mg,intravenous injection,1 times/day,2 weeks later changed to oral administration),in which 4 patients got better,while 1 patient died.With the drugs combination,3 patients were treated with voriconazole and amphotericin,among which 1 patient died;5 patients were treated with caspofungin and voriconazole,among which 1 died during the drugs using,and the other patients got better.Conclusion:1.According to the epidemiological investigation,the incidence of invasive pulmonary aspergillosis has increased year by year,and patients with high risk factors of invasive diseases should highly consider about this disease.2.Cases of pulmonary tuberculosis combined with pulmonary aspergillosis are not rare in clinical practice.Clinicians can consider the aspergillus related examination for patients with pulmonary tuberculosis during the use of anti-tube drugs,when the patients' condition gets worse or when the chest radiography presents new imaging characteristics.3.The clinical and imaging characteristics of invasive aspergillus are not typical,and there is no diagnostic test has been testified to be sensitive or specific yet.4.Voriconazole has good curative effect as a first-line drug for the treatment of invasive pulmonary aspergillosis,and a combination of drugs can be adopted when the patients' condition aggravates,while fluconazole is ineffective for the treatment of this disease. |
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