Clinical Characteristics Analysis Of Chronic Obstructive Pulmonary Disease With Invasive Pulmonary Aspergillosis

Objective: To explore the clinical features and risk factors of chronic obstructive pulmonary disease(COPD)combined with invasive pulmonary aspergillosis(IPA),and to provide help for clinical work.Methods: A retrospective analysis was performed on the patient data of patients admitted to Ningxia People's Hospital from January 2015 to December 2019.36 patients with COPD and IPA diagnosed by our hospital were selected as the case group,and 36 patients with simple COPD without IPA were used as control group.Record relevant indicators: 1.General information: age,gender,smoking history,length of hospital stay,duration of COPD,etc;2.Comorbidities: whether combined with hypertension,diabetes and coronary heart disease,etc;3.Diagnosis and treatment measures: whether to perform invasive procedures,Mechanical ventilation and the use of hormones and antibiotics;4.Clinical manifestations: whether fever,cough,sputum,etc;auscultation of both lungs with or without snoring;5.Laboratory examinations: blood routine,blood gas analysis,etc;6.Refer to 2017 Global Initiative for Chronic Obstructive Lung Disease(GOLD)grades the severity of COPD.SPSS 19.0 software was used to analyze the statistical difference of the summary data.Finally,statistically significant factors(P <0.05)were used to explore the main risk factors for IPA in COPD with binary logistic regression analysis.The sputum culture,serum GM test,chest CT manifestation,treatment and outcome were analyzed in the case group.Results: 1.According to univariate analysis,length of stay ? 2 weeks,hypoxemia,hypoproteinemia,use of broad-spectrum antibiotics ? 3,long-term systemic use of steroids had statistical differences(P <0.05).2.Binary Logistic regression analysis found that the length of stay ? 2 weeks,hypoxemia,and the use of broad-spectrum antibiotics ? 3 were statistically significant(P <0.05).3.Cough,expectoration,wheezing,and fever are common in the case group.The incidence of hemoptysis in the case group is higher than that in the control group,and the difference is statistically significant(P <0.05).4.The white blood cell count of the case group was higher than that of the control group,and the arterial oxygen partial pressure and average albumin level were lower than those of the control group,and the differences were statistically significant(P <0.05).5.Case group pathogenicity: Thepositive rate of serum GM test was 36.11%;the positive rate of lower respiratory sputum culture was 77.78%,and the highest proportion was Aspergillus fumigatus(41.67%).6.COPD combined with IPA chest CT is mainly characterized by non-specific signs of airway invasion(bronchial wall thickening,infiltration around the bronchi,tree bud signs).Typical diagnostic signs of vascular invasion(halo sign,crescent sign,subpleural wedge-shaped solid Change,etc.)rare;the lesions are mainly distributed along the vascular / bronchial bundle,and then along the pleura,and both can coexist;15 patients(41.67%)showed emphysema on CT.7.Patients in the case group were all treated with antifungal therapy,mainly voriconazole.21 cases(58%)improved,5 cases(14%)worsened,8 cases(22%)were automatically discharged,and 2 cases(5%)died.Conclusion: 1.Patients with COPD who have a Length of stay? 2 weeks,use of broadspectrum antibiotics?3,long-term systemic application of steroid hormones,and hypoxemia and hypoproteinemia may be prone to secondary IPA.2.The clinical manifestations of COPD combined with IPA are common with cough,sputum,wheezing,and fever,and hemoptysis may have some implications.3.When the patients with COPD have the above factors and symptoms and the conventional treatment is not effective,we should be alert to the possibility of IPA,and we should complete the GM experiment and sputum culture as early as possible to find the pathogenic evidence.4.Nonspecific signs are more common in COPD with IPA chest CT.