慢性阻塞性肺疾病并侵袭性肺曲霉菌病患者的临床表现及胸部 Ct 表现分析

摘要

目的：分析慢性阻塞性肺疾病（COPD）并侵袭性肺曲霉菌病（ IPA）患者的临床表现及胸部 Ct 表现。方法选择2010年3月—2015年3月海阳市人民医院收治的 COPD 并 IPA 患者33例作为观察组，另按照1：1匹配原则选择同期同性别、年龄相差≤3岁、COPD 病程相差≤3年的 COPD 未并发 IPA 患者33例作为对照组。回顾性分析 COPD 并 IPA 患者的胸部 Ct 表现，并比较两组患者基础疾病、吸烟情况、用药情况、实验室检查指标及临床表现。结果 COPD 并 IPA 患者的主要胸部 Ct 表现为斑片渗出影25例（75.8&）、晕轮征21例（63.6&）、双肺纹理粗乱17例（51.5&）、实变影15例（45.5&）。两组患者2型糖尿病发生率、高血压发生率、冠心病发生率、激素使用率、广谱抗生素使用率、红细胞沉降率、D -二聚体、C 反应蛋白及降钙素原水平比较，差异均无统计学意义（P >0.05）；观察组患者吸烟率高于对照组，血清清蛋白水平正常者所占比例低于对照组（ P <0.05）。两组患者呼吸困难、咳嗽、发热、咯血、乏力、胸痛、肺部啰音发生率比较，差异均无统计学意义（P >0.05）。结论 COPD 并 IPA 患者无特异性临床表现，胸部 Ct 主要表现为斑片渗出影、晕轮征、双肺纹理粗乱及实变影，且吸烟、血清清蛋白水平较低可能是COPD 患者并发 IPA 的影响因素。%Objective to analyze the clinical features and chest Ct features of chronic obstructive pulmonary disease patients complicated with invasive pulmonary aspergillosis. Methods A total of 33 chronic obstructive pulmonary disease patients complicated with invasive pulmonary aspergillosis were selected as observation group in the People′s Hospital of Haiyang from March 2010 to March 2015,a total of 33 chronic obstructive pulmonary disease patients were selected as control group according to 1: 1 matching principle(same gender,age difference equal or less than 3 years,COPD course difference equal or less than 3 years). Chest Ct features of A group were retrospectively analyzed,underlying disease,smoking status,drug usage,laboratory examination index and clinical features were compared between the two groups. Results Of observation group,chest Ct found that,25 cases(75. 8& )performed as plaque - like effusion shadows,21 cases(63. 6& )performed as halo signs,17 cases( 51. 5& ) performed as bilateral lung marking thickening and in a mess,15 cases( 45. 5& ) performed as consolidation shadows. No statistically significant differences of incidence of type 2 diabetes mellitus,hypertension or coronary heart disease,usage rate of hormone or broad - spectrum antibiotic,erythrocyte sedimentation rate,D - dimer,C -reactive protein or procalcitonin was found between the two groups( P > 0. 05 );smoking rate of observation group was statistically significantly higher than that of control group,while the proportion of patients with normal serum albumin level of observation group was statistically significantly lower than that of control group ( P < 0. 05 ). No statistically significant differences of incidence of dyspnea,cough,fever,hemoptysis,lacking in strength,chest pain or lung rale was found between the two groups(P > 0. 05). Conclusion the clinical features of chronic obstructive pulmonary disease patients complicated with invasive pulmonary aspergillosis are not specific,the main chest Ct features includes plaque - like effusion shadows,halo signs,bilateral lung marking thickening and in a mess,consolidation shadows and so on,smoking and reduced serum albumin level may be the influencing factors of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.