肝衰竭合并侵袭性肺曲霉菌病的危险因素和胸部影像特征分析

目的：探讨肝衰竭患者合并侵袭性曲霉菌病的临床特征、危险因素及胸部影像特征。方法对20例肝衰竭合并肺侵袭性曲霉菌病（IPA）的临床特征、实验室指标以及胸部CT进行回顾性分析。结果463例肝衰竭患者中发生侵袭性曲霉菌病20例（4.3%），其中药物性肝病7例、自身免疫性肝病6例、代谢性肝病2例、乙型肝炎5例。肝衰竭合并IPA的危险因素包括：70%患者长期使用2种以上抗生素，60%患者有糖皮质激素暴露史，55%患者CD4＋T淋巴细胞计数≤400/mm3。胸部平片缺乏特征性改变，而肺部CT改变以双肺多发结节和近胸膜楔形实变最为常见，晕轮征和新月形空气征较少。5例IPA患者经伏立康唑治愈,其余死亡或自动出院。结论肝衰竭患者易发侵袭性肺曲霉菌病，多数患者具有深部真菌感染的危险因素，胸部CT特征对于肝衰竭合并IPA具有重要的提示价值。

Imaging features and risk factors of invasive pulmonary aspergillosis in patients with liver failure

Objective To explore clinical characteristic, diagnosis and risk factors and chest imagine features of invasive pulmonary aspergillosis in patients with liver failure. Methods The clinical data of 20 cases with IPA in patients with liver failure from January 2008 to November 2012 in our hospital were retrospectively analyzed. Results Total of 463 cases with liver failure, 20 cases was diagnosed with invasive pulmonary aspergillosis, and all case were “probable” cases,incidence rate of IPA in liver failure was 4.3 percent. Among these cases, 7 case with drug induced liver injury, 6 cases with autoimmune hepatitis, 2 cases with metabolic liver disease, 5 cases with viral hepatitis B. The risk factors of IPA in these cases include that 70% cases received long term broad spectrum antibiotic treatment, 60% cases had glucocorticoids exposure, 55% cases presented CD4＋ T cell count below 400/mm3. Chest CT scan show that multiple nodules or masses and wedge consolidation near pleura is common change in bilateral lung, but typical halo sign and air-crescent sign is seen rarely. In those IPA patients, 5 cases recovered with voriconazole treatment, others died or discharged voluntarily during therapy. Conclusions Patients with liver failure is susceptible to invasive pulmonary aspergillosis, most IPA cases presents host risk factors, chest CT scan have an important value to discover IPA early in those patients.