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目的观察糖尿病伴侵袭性肺曲霉菌病(IPA)的临床特点并分析其危险因素。方法选取糖尿病伴IPA患者(DM+IPA组)38例和单纯糖尿病患者(DM组)40例。收集两组临床资料及生化指标。Logistic回归分析糖尿病伴IPA的危险因素。结果 (1)DM+IPA组以咳嗽、咳痰(42.11%),发热(42.11%)为主要临床表现,CT检查常可见薄壁空洞伴空气“新月征”(39.47%)和周围“晕轮征”(34.21%)。予抗真菌治疗,治疗总有效率为57.89%,病死率为28.95%;(2)DM+IPA组病程[(13.37±2.14)vs(11.42±2.25)年]、FPG[(17.84±3.15)vs(7.52±1.84)mmol/L]、2hPG[(22.90±4.63)vs(9.71±2.75)mmol/L]、HbA1c[(9.03±2.65)%vs(7.30±2.22)%]、血沉(ESR)[(94.62±31.49)vs(16.57±4.16)mm/h]、C-RP[(55.42±30.19)vs(1.67±0.22)mg/L]、降钙素原(PCT)[(1.20±1.10)vs(0.07±0.05)ng/ml]及D-二聚体水平[(475.81±183.62)vs(320.34±105.11)μg/ml]均高于DM组(P<0.05或P<0.01);(3)Logistic回归分析显示,年龄、糖尿病病程、FPG、HbA1c是糖尿病伴IPA的危险因素(P<0.05或P<0.01)。结论糖尿病伴IPA患者病情严重,治愈率低,病死率高,以咳嗽、咳痰、发热为主要表现,以“新月征”“晕轮征”为影像学特点。高龄、病程长、血糖控制差可能是糖尿病伴IPA的危险因素。
Objective To observe the clinical features of diabetes with invasive pulmonary aspergillosis (IPA) and analyze its risk factors. Methods Thirty-eight patients with diabetes mellitus (IPA) and 40 patients with diabetes mellitus (DM) were enrolled. Two sets of clinical data and biochemical indexes were collected. Logistic regression analysis of risk factors of diabetes with IPA. Results (1) The main clinical manifestations of cough, sputum (42.11%) and fever (42.11%) were found in DM + IPA group. Thin-walled cavity with air “crescent sign” (39.47% “Halo wheel levy ” (34.21%). The total effective rate was 57.89% and the mortality rate was 28.95%. (2) The course of DM + IPA group was (13.37 ± 2.14) vs (11.42 ± 2.25) years, FPG was (17.84 ± 3.15) vs (7.52 ± 1.84) mmol / L], 2hPG [(22.90 ± 4.63) vs (9.71 ± 2.75) mmol / L] (94.62 ± 31.49 vs 16.57 ± 4.16 mm / h), C-RP (55.42 ± 30.19 vs 1.67 ± 0.22 mg / L, respectively), procalcitonin (0.07 ± 0.05) ng / ml and D-dimer [(475.81 ± 183.62) vs (320.34 ± 105.11) μg / ml] were higher than those in DM group (P <0.05 or P <0.01) Logistic regression analysis showed that age, duration of diabetes, FPG and HbA1c were risk factors of diabetes with IPA (P <0.05 or P <0.01). Conclusion The patients with diabetes mellitus complicated with IPA have serious illness, low cure rate and high case fatality rate, with cough, sputum aspiration and fever as the main manifestations, with “new moon sign” and “halo sign” as imaging features. Elderly, long course of disease, poor blood glucose control may be diabetes with IPA risk factors.