High-risk Factors,Clinical Features,treatment And Prognosis Of COPD With IPA

Background:Invasive pulmonary aspergillosis?IPA?is a life-threatening necrotizing pneumonia caused by Aspergillus invading the lung parenchyma and is accompanied by an opportunistic fungal infection of the genus Aspergillus.This opportunistic disease mainly occurs in immunocompromised hosts,such as hematological malignancies,allogeneic bone marrow transplantation,solid organ transplantation,and advanced HIV infection.In addition to these high-risk groups,there are many non-traditional host cases,particularly patients with chronic obstructive pulmonary disease?COPD?,and it has been demonstrated that COPD patients are at high risk of IPA.Chronic obstructive pulmonary disease?COPD?is a common respiratory disease in elderly patients.The destructiveness of the disease results in irreversible damage to lung function and high mortality.However,patients with chronic obstructive pulmonary disease suffer from changes in lung structure,impaired airway mucosal barrier function,reduced ciliary self-purification,and impaired cellular immune function,and long-term treatment with inhaled corticosteroids,acute phase requires intravenous use of antibiotics,corticosteroids,increased the fungal infectionsopportunity such as Aspergillus,resulted in an increase of COPD combined with IPA.The main clinical manifestations and radiologic features of COPD combined with IPA are not specific.In addition,poor basic conditions make it difficult to tolerate biopsy,and it is not easy to obtain the required tissue samples.Therefore,it is difficult to obtain a definite diagnosis of COPD combined with IPA in the early stage,resulting in delay in the treatment of Aspergillus spp,the mortality rate is high.It is of great significance to actively and effectively prevent COPD from merging with IPA.Objective:This article through case-control study analysis of COPD with IPA high-risk factors,clinical features,treatment and prognosis,designed to provide the basis for prevention and control of IPA,improve the understanding of medical workers to the disease,to achieve early diagnosis and early treatment,reduce mortality,improve the prognosis.Methods:We retrospectively analyzed 50 patients with COPD combined with IPA diagnosed in our hospital from January 2010 to December 2016 as IPA group and 50 patients with simple COPD as control group.We reviewed two groups of 100 medical records and developed a unified questionnaire.fill in.The survey indicators include:?1?General conditions:age?60 years old,smoking history,hospitalization time?20d,whether ICU admission,diabetes mellitus?DM?,and liver and kidney function damage;?2?Treatment measures:invasive Operation?tracheal intubation or tracheotomy,insertion of gastric tube,central venous catheter,etc.?mechanical ventilation?MV?,use of corticosteroids??2weeks?and antibiotics??2weeks?;?3?Test indicators:white blood cells?WBC?10×10⁹/L?,C-reactive protein?CRP?10mg/L?,neutrophil absolute value?N?7×10⁹/L?,and albumin?ALB<30g/L?,arterial oxygen partial pressure?PaO₂<60mmHg?etc.;?4?According to the classification of lung function,COPD was classified into light,moderate,severe,and extremely severe Statistical analysis was used to analyze the data of the above two groups of patients,and a meaningful?p<0.05?data was used to investigate the major risk factors for IPA in COPD by logistic multivariate analysis.And by reviewing the clinical manifestations,specific tests,treatment and prognosis of IPA patients in this study,further analysis and discussion.Results:?1?There are statistics on whether the ICU,DM,ALB<30g/L,MV,invasive operation,long-term use of steroids??2weeks?,long-term use of antibiotics??2weeks?,extremely severe COPD and other clinical indicators in the two groups of patients differences?P<0.05?.?2?There were statistically significant factors?P<05?,such as hypoproteinemia,mechanical ventilation,invasive operation,long-term use of corticosteroids,long-term use of antibiotics,extremely severe COPD.?3?The common clinical manifestations of patients with COPD combined with IPA were non-specific;CT showed common non-specific infiltrates,typical"halo signs"and"new moon signs"are rare.GM test and lower respiratory tract?LRT?sample culture have guiding significance for the diagnosis of this disease.?4?The delay in the diagnosis and treatment of COPD combined with IPA results in high mortality.Conclusion:?1?The incidence of COPD and IPA is gradually increasing.Because the main clinical manifestations and radiological images are not specific,and the confirmed tissue samples are usually difficult to obtain,it is difficult to diagnose and treat early,and the mortality rate is high.?2?ICU admission,DM,ALB<30g/L,MV,invasive operation,long-term use of steroids??2weeks?,long-term use of antibiotics??2weeks?,and extremely severe COPD were the influencing factors for COPD combined with IPA.?3?ALB<30g/L,MV,invasive operation,long-term use of corticosteroids,long-term use of antibiotics,extremely severe COPD and other factors are the main risk factors for COPD with IPA.?4?The clinical manifestations of patients with COPD combined with IPA were non-specific,CT showed no specificity,common infiltrates,IPA typical"halo sign"and"new moon sign"are less common,but indicative significance.The GM experiment and the LTR specimen microorganism culture is significant to the diagnosis of Aspergillus,but the diagnosis requires tissue biopsy.In the clinical work,it is often difficult to obtain a biopsy specimen because of the poor tolerance of patients with advanced COPD.?5?For COPD patients receiving antibiotics??2 weeks?and corticosteroid??2weeks?and patients with adverse clinical conditions?mechanical ventilation,invasive procedures,and hypoalbuminemia?,after treatment there is no significant improvement in respiratory symptoms,CT is not obvious improvement,should be submitted as soon as possible examination of fungal culture and identification of LRT specimens,monitoring of GM experiments,conditions permitting feasible biopsy to assist in the diagnosis,and at the same time as soon as possible to start the antifungal treatment according to experience,choice voriconazole.Early treatment of patients with high-risk factors can improve the prognosis of COPD patients with IPA and reduce mortality.