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目的分析侵袭性肺曲霉菌病(IPA)的临床特征。对13例确诊IPA患者的宿主因素、临床特征、治疗及转归进行回顾性分析。方法继发性IPA患者中恶性肿瘤放化疗后发病率最高,其临床表现主要有发热、咳嗽、咳痰、呼吸困难、咯血。IPA患者的肺CT改变呈多样性,并呈动态演变。结果组织病理学和(或)微生物学可做出诊断。给予伏立康唑静脉+口服序贯治疗有较高的治疗有效率。结论 IPA多为继发,其临床及影像学表现无特异性,病情进展迅速,误诊率较高。诊断本病需结合基础病史、糖皮质激素或广谱抗生素、免疫抑制剂使用史、影像学表现及实验室检查结果,确诊靠组织学检查。治疗方面主要是早期使用抗真菌药物,伏立康唑单用治疗有效率较高。对疑诊IPA的患者早期给予抗真菌治疗可提高治疗成功率。
Objective To analyze the clinical features of invasive pulmonary aspergillosis (IPA). The host factors, clinical features, treatment and prognosis of 13 patients with confirmed IPA were analyzed retrospectively. Methods The incidence of malignant tumors in patients with secondary IPA was the highest after radiotherapy and chemotherapy. The main clinical manifestations were fever, cough, sputum, dyspnea and hemoptysis. IPA patients showed a variety of pulmonary CT changes, and showed a dynamic evolution. Results Histopathology and / or microbiology can make a diagnosis. Voriconazole given intravenously + oral sequential therapy has a higher therapeutic efficiency. Conclusions IPA is mostly secondary and has no specific clinical and imaging findings. The disease progresses rapidly and the misdiagnosis rate is high. Diagnosis of the disease need to be combined with the basic history, glucocorticoid or broad-spectrum antibiotics, immunosuppressive agents history, imaging findings and laboratory test results, confirmed by histological examination. Treatment is mainly the early use of antifungal drugs, voriconazole single treatment is more effective. Early anti-fungal treatment in patients with suspected IPA can improve the success rate of treatment.