128例侵袭性肺曲霉病临床疗效分析

目的 通过回顾性病例分析,加强对侵袭性肺曲霉病的认识,重视对侵袭性肺曲霉病的分级诊断,从而制定合理治疗方案.方法 对四川大学华西医院201 1年1 ～12月128例诊断为侵袭性肺曲霉病患者的临床资料进行回顾性分析,重点分析基础疾病、临床表现、影像学表现、诊断及治疗方法.结果 确诊17例;依据宿主危险因素、临床表现及反复痰培养阳性拟诊111例.128例患者均伴有基础疾病.治疗方案包括伏立康唑（86例）,两性霉素B脂质体（1例）,伊曲康唑（12例）,米卡芬净（3例）,卡泊芬净（3例）,两性霉素B去氧胆酸盐（10例）,伏立康唑联合米卡芬净（1例）.治愈或好转81例（63.28％）,自动出院24例（18.75％）,死亡23例（17.97％）.结论 侵袭性肺曲霉病患者多数伴有多种感染危险因素,应当重视侵袭性肺曲霉病的分级诊断,据不同情况给予适当抗真菌治疗,以降低患者病死率.

The treatment of 128 patients with invasive pulmonary aspergillosis

Objective To improve understanding of invasive pulmonary asperginosis （IPA） and pay more attention to the classification of IPA so as to provide evidences for rational antifungal chemotherapy.Method The clinical features of 128 cases of IPA were analyzed retrospectively in West China Hospital of Sichuan University from January to December in 2011.This study focused on the risk factors,clinical manifestations,imaging findings,diagnosis and treatment methods.A total of 128 patients were enrolled.Results Seventeen patients were confirmed IPA by the positive culture results from the specimens collected by the bronchoscopy.One hundred and eleven patients were diagnosed as probable IPA.All patients had underlying diseases.All patients accepted antifungal treatment.The antifungal agents included voriconazole （86）,amphotericin B liposome （1）,itraconazole （12）,micafindan （3）,capofungin （15）,amphotericin B （10） and voriconazole combined with caspofungin （1）.Eighty-one patients （63.28%） were cured or improved.Twenty-four patients （18.75%） discharged from hospital due to poor economic conditions.Twenty-three patients （17.97%） died.Conclusion Most IPA patients had a variety of risk factors for infection.To reduce mortality rate of IPA,we should pay more attention to its stratification diagnosis,and choose appropriate antifungal agents.