2型糖尿病合并侵袭性肺曲霉病9例临床分析

摘要

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .%目的：探讨2型糖尿病合并侵袭性肺曲霉病的临床特点及预后，加强临床医师对该病的警惕及认识，提高早期诊疗水平。方法回顾性分析2008年1月—2013年12月在青岛市市立医院呼吸科收治的9例单纯2型糖尿病合并侵袭性肺曲霉病患者的临床资料。结果9例2型糖尿病合并侵袭性肺曲霉病患者中确诊5例，临床诊断4例；临床表现以发热、咳嗽、咯痰为主；肺CT表现以沿支气管血管束分布的结节影，空洞征为主，支气管镜检查镜下可见气管或支气管黏膜充血水肿，局部黄白色或褐色脓苔覆盖，部分或完全阻塞管腔；经抗真菌治疗后4例好转，5例死亡。结论2型糖尿病是发生侵袭性肺曲霉病的高危因素，早期诊断与及时治疗是改善2型糖尿病合并侵袭性肺曲霉病预后的关键。