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目的探讨非粒细胞缺乏患者侵袭性肺曲霉菌病(IPA)的临床表现、诊断和治疗特点。方法回顾性分析我院2009年3月至2010年8月收治的9例IPA的基础疾病、危险因素、临床表现、实验室及影像学特征、治疗和预后情况。结果 9例IPA患者确诊2例,临床诊断7例。2例患者无特殊病史,其余7例均有基础疾病。主要症状为发热、咳嗽、咯痰、咯血、胸闷和气喘。痰培养6例查见曲霉菌。G试验及GM试验阳性5例。2例支气管镜检查病理形态学及特殊染色结果符合曲霉菌感染。影像学表现呈多样性。9例患者均接受抗真菌药物治疗,其中8例随诊,失访1例。5例选用伏立康唑初始治疗;3例初始治疗分别为伊曲康唑、米卡芬净及卡泊芬净,治疗效果欠佳,换用伏立康唑仍有良好疗效。结论非粒细胞缺乏IPA患者临床表现缺乏特异性,早期诊断和尽早应用抗曲霉菌药可降低病死率。
Objective To investigate the clinical manifestations, diagnosis and treatment of invasive pulmonary aspergillosis (IPA) in non-granulocytic patients. Methods A retrospective analysis of 9 cases of IPA in our hospital from March 2009 to August 2010 were included in the basic diseases, risk factors, clinical manifestations, laboratory and imaging features, treatment and prognosis. Results Of the 9 IPA patients, 2 were diagnosed and 7 were diagnosed clinically. Two patients had no special medical history, and the remaining seven patients had underlying diseases. The main symptoms are fever, cough, expectoration, hemoptysis, chest tightness and asthma. Six cases of sputum culture found aspergillus. G test and GM test were positive in 5 cases. 2 cases of bronchoscopy pathological morphology and special staining results consistent with Aspergillus infection. Imageology showed a diversity. Nine patients were treated with antifungal drugs, of which 8 cases were followed up, 1 patient was lost. 5 cases of voriconazole initial treatment; 3 cases of initial treatment were itraconazole, micafungin and caspofungin net, poor treatment, for voriconazole still have good effect. Conclusion The clinical manifestations of patients with non-granulocytic deficiency IPA lack of specificity, early diagnosis and early application of anti-Aspergillus drugs can reduce the mortality.