【摘 要】
：
目的 分析2型糖尿病合并侵袭性肺曲霉病(IPA)的临床特点.方法 回顾性分析2015年5月至2020年3月郑州大学第一附属医院收治的10例2型糖尿病合并IPA患者的临床症状、实验室检验指标、胸部计算机体层成像(CT)、支气管镜下表现、治疗及预后.结果 10例患者中男4例,女6例,确诊9例,临床诊断1例.临床症状表现为咳嗽10例、咳黄痰4例、咳灰黄色痰1例、胸闷6例、发热5例、胸痛2例、痰中带血1例.痰培养阳性率为20.00％(2/10),支气管肺泡灌洗液(BALF)培养阳性率为42.86％(3/7),共检
【机 构】
：
郑州大学第一附属医院 呼吸与危重症医学科,河南 郑州 450000
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目的 分析2型糖尿病合并侵袭性肺曲霉病(IPA)的临床特点.方法 回顾性分析2015年5月至2020年3月郑州大学第一附属医院收治的10例2型糖尿病合并IPA患者的临床症状、实验室检验指标、胸部计算机体层成像(CT)、支气管镜下表现、治疗及预后.结果 10例患者中男4例,女6例,确诊9例,临床诊断1例.临床症状表现为咳嗽10例、咳黄痰4例、咳灰黄色痰1例、胸闷6例、发热5例、胸痛2例、痰中带血1例.痰培养阳性率为20.00％(2/10),支气管肺泡灌洗液(BALF)培养阳性率为42.86％(3/7),共检出4例曲霉菌感染.血清半乳甘露聚糖(GM)试验阳性1例(10.00％),血清(1,3)-β-D-葡聚糖(G)试验阳性2例(20.00％).3例患者接受BALF GM试验,均为阴性.胸部CT表现为双肺多发支气管周围渗出影4例、小结节影2例,可融合为结节状或片状实变影,边界模糊,密度不均,伴空洞形成;3例表现为单发厚壁空洞,空洞内有线样分隔影;1例表现为大片实变影.8例患者经支气管镜检查,镜下均显示双肺多段支气管管腔受累,5例管腔附着白色坏死物,3例部分管腔狭窄,2例管腔阻塞,另可见白色伪膜形成1例、黏膜充血肥厚2例、管腔内大量脓性分泌物3例.全身用抗真菌药物联合局部支气管镜下治疗后,6例好转,3例病情进展,1例病情稳定.结论 2型糖尿病合并IPA的临床症状缺乏特异性,胸部CT以双肺多发支气管周围渗出、小结节影、空洞形成为主,尽早开展支气管镜检查对其诊治至关重要.
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