非肺移植宿主侵袭性气管支气管曲霉病的临床特征和预后分析

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摘要目的：探讨非肺移植宿主侵袭性气管支气管曲霉病（ITBA）的临床特征和预后。方法：回顾性分析自2002年3月至2015年6月间收住温州医科大学附属第一医院呼吸与危重症医学科，确诊为ITBA的19例非肺移植宿主的病例资料，排除气道寄生型的曲霉病和变应性支气管肺曲霉病（ABPA），记录患者的临床资料、基础疾病、实验室指标、支气管镜表现和影像学资料及预后。结果：慢性呼吸道疾病（CRD）、糖尿病和恶性肿瘤为主要基础疾病，未发现基础疾病6例，占33%CRD、糖尿病和免疫功能正常宿主ITBA初始均表现为孤立性曲霉性气管支气管炎，随病情进展可侵袭肺实质，发生侵袭性肺曲霉病（IPA）；支气管镜多表现为伪膜型，病情进展后表现为溃疡型，病死率为52.6%（10/19），一旦气管插管呼吸机支持，病死率达100%。恶性肿瘤以血液恶性肿瘤、肺癌为主要基础疾病，血液恶性肿瘤的ITBA常继发于IPA，支气管镜表现为局灶性，以伪膜混合溃疡坏死为主，2例患者死于曲霉相关的大出血。无基础疾病宿主发生ITBA预后明显好于有基础疾病患者。结论：非肺移植宿主ITBA以CRD、糖尿病和恶性肿瘤为常见的基础疾病，也见于无基础疾病宿主。初始以孤立性ITBA为主，支气管镜表现以近段气道、伪膜型为主；血液恶性肿瘤ITBA常继发于IPA，病变局灶，表现为伪膜混合溃疡型。有基础疾病宿主预后差。

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	苏珊珊
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	吴庆
	李玉苹

关键词 ：侵袭性气管支气管曲霉病, 伪膜型气管支气管炎, 溃疡型气管支气管炎

Abstract：Objective: To explore the clinical features and prognosis of invasive tracheobronchial aspergillosis (ITBA) in non-lung transplantation hosts. Methods: Nineteen cases of non-lung transplantation who admitted to the department of pulmonary and critical care medicine of the First Affiliated Hospital of Wenzhou Medical University from March 2002 to June 2015, for whom ITBA were confirmed by microbiologic culture and histopathology, were enrolled and all data were retrospectively analyzed. Results: Chronic respiratory diseases (CRD), diabetes mellitus and malignant tumor were the most common underlying diseases. ITBA could be diagnosed in immunocompetent host. In non-lung transplantation and non-malignant tumor hosts, at first, isolated tracheobronchitis was the most common manifestation, pseudomembranous form of ITBA was the major appearance under bronchoscopy. With the diseases progression, different features and extent of pulmonary involvement could be seen, ulcerative tracheobronchitis increased significantly, the total mortality was 52.6%, mortality increased to 100% when received mechanical ventilation. In patients with hematological malignancies, ITBA was often with IPA, under bronchoscopy, ulcerative and pseudomembranous forms of lobar bronchi were present in 2 cases, another patient of metastatic lung cancer who received radiotherapy, ITBA was also located in middle lobe and ulcerative form. Two of three patients died of massive hemoptysis. Conclusion: CRD, diabetes mellitus and malignant tumor are the most common underlying diseases of ITBA in non-lung transplantation hosts, it can also occur in immunocompetent host. Isolated tracheobronchitis and pseudomembranous form are the initial manifestations; In patients with hematological malignancies, ITBA is often with IPA, ulcerative and pseudomembranous forms of drainage bronchi were present. ITBA with underlying diseases have poor prognosis.

Key words： invasive tracheobronchial aspergillosis pseudomembranous tracheobronchitis ulcerative tracheobronchitis

收稿日期: 2015-09-14

基金资助:浙江省科技厅课题（2013C33172）；温州市科技计划项目（Y20120232）。

通讯作者: 李玉苹，主任医师，教授，硕士生导师，Email：wzliyp@163.com。

作者简介: 苏珊珊（1991-），女，浙江温州人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2016/V46/I2/79

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