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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 229 -233. doi: 10.3877/cma.j.issn.1674-6902.2024.02.011

论著

肺曲霉菌病患者的影像学及临床特征分析
游雅婷1, 刘熙1, 白莉1,†(), 郭亮1,†()   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学科
  • 收稿日期:2024-01-07 出版日期:2024-04-25
  • 通信作者: 白莉, 郭亮
  • 基金资助:
    重庆市自然科学基金(CSTB2023NSCQ-MSX0936)

Analysis of imaging and clinical features of patients with pulmonary aspergillosis

Yating You1, Xi Liu1, Li Bai1,†(), Liang Guo1,†()   

  1. 1. Institute of Respiratory Disease, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China
  • Received:2024-01-07 Published:2024-04-25
  • Corresponding author: Li Bai, Liang Guo
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游雅婷, 刘熙, 白莉, 郭亮. 肺曲霉菌病患者的影像学及临床特征分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 229-233.

Yating You, Xi Liu, Li Bai, Liang Guo. Analysis of imaging and clinical features of patients with pulmonary aspergillosis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(02): 229-233.

目的

分析有或无基础疾病患肺曲霉菌病(pulmonary aspergillosis)的流行病学，早期识别肺曲霉菌病患者的特征，以指导临床诊疗。

方法

回顾性分析2020年9月至2022年7月我院收治的肺曲霉菌病患者39例为对象，分无基础疾病为观察组17例和有基础疾病组为对照组22例，收集患者的性别、年龄、职业；症状，糖皮质激素使用史，抗生素使用史，胸部影像学特征及实验室检查，包括血常规、血沉、肝功能、肾功能、凝血功能、D-二聚体，比较两组数据。

结果

39例肺曲霉菌病患者中，年龄大于60岁观察组3例(17.65%)，对照组13例(59.09%)(P<0.05)；糖皮质激素使用史对照组7例(31.82%)，观察组17例中无使用者(P<0.05)；胸部影像不规则高密度影观察组7例(41.18%)，对照组17例(77.27%)(P<0.05)；肺部单侧病变观察组13例(76.47%)，对照组7例(31.82%)(P<0.05)；观察组尿素氮5.58[3.85～6.3]mmol/L，D-二聚体0.14[0.08～0.44]mg/L低于对照组6.67[5.09～10.53]mmol/L，0.73(0.26～1.17)mg/L(P<0.05);观察组血红蛋白130.00(124.00～134.00)g/L，总蛋白(69.60±7.41)g/L，白蛋白40.90(33.15～43.75)g/L高于对照组106.00(85.75～117.00)g/L，(58.90±9.45)g/L，31.70(27.93～38.93)g/L(P<0.05)。

结论

肺曲霉菌病可发生在肺部单侧，以肺结节、肺空洞及不规则高密度阴影表现；高龄、尿素氮、血红蛋白、总蛋白、白蛋白水平和D二聚体浓度是区别有无基础疾病患肺曲霉菌病的主要因素。

关键词: 肺曲霉菌病, 影像学, 临床特征
Objective

To analyze the epidemiological characteristics of pulmonary aspergillosis (PA) with or without underlying diseases, and to early identify the characteristics of pulmonary aspergillosis without underlying diseases to guide clinical diagnosis and treatment.

Method

A total of 39 patients with pulmonary aspergillosis admitted to our hospital from September 1, 2020 to July 1, 2022 were retrospectively analyzed. They were divided into the observation group 17 cases without underlying diseases and the control group 22 cases with underlying diseases. The gender, age, occupation, symptoms, history of glucocorticoid use, history of antibiotic use, chest imaging characteristics and laboratory examination of the patients were collected. Including blood routine, erythrocyte sedimentation rate, liver function, renal function, coagulation function, D-dimer, the two groups were statistically analyzed.

Result

Among the 39 patients with pulmonary aspergillosis, there were 3 cases (17.65%) in the observation group and 13 cases (59.09%) in the control group aged over 60 years (P<0.05). There were 7 cases (31.82%) of glucocorticoid use history in the control group, and no cases in the observation group, the difference between the two groups was statistically significant (P=0.012). There were 7 cases (41.18%) of irregular high density shadow in the observation group and 17 cases (77.27%) in the control group (P<0.05). There were 13 cases (76.47%) in the observation group and 7 cases (31.82%) in the control group with unilateral lung lesions (P<0.05). Blood urea nitrogen 5.58[3.85-6.3]mmol/L in the observation group, 6.67[5.09-10.53]mmol/L in the control group (P<0.05), D-dimer 0.14[0.08-0.44]mg/L in the observation group, 0.73(0.26-1.17)mg/L in the control group, the difference was statistically significant (P<0.05). The difference between the two groups was statistically significant (P<0.05). Hemoglobin was 130.00(124.00-134.00)g/L in the observation group and 106.00(85.75-117.00)g/L in the control group (P<0.05). Total protein was(69.60±7.41)g/L in the observation group and (58.90±9.45)g/Lin the control group (P<0.05). Albumin was 40.90(33.15-43.75)g/L in the observation group and 31.70(27.93-38.93)g/L in the control group (P<0.05).

Conclusions

Pulmonary aspergillosis can occur in one side of the lung, pulmonary nodules, pulmonary cavities and irregular high-density shadows. Advanced age, blood urea nitrogen, hemoglobin, total protein levels, albumin levels and D-dimer are the main factors to distinguish pulmonary aspergillosis with or without underlying diseases.

Key words: Pulmonary aspergillosis, Imaging, Clinical features
表1 两组肺曲霉菌病患者的基线特征及临床表现[n(%)]
临床资料 观察组(n＝17) 对照组(n＝22) P值
男性 9(52.94) 11(50.00) 1
年龄(>60岁) 3(17.65) 13(59.09) 0.020
咳嗽 15(88.24) 17(77.27) 0.438
发热 3(17.65) 8(36.36) 0.288
呼吸窘迫 3(17.65) 10(45.45) 0.093
咯血或痰血 7(41.18) 9(40.91) 1
胸痛 4(23.53) 3(13.64) 0.677
糖皮质激素使用史 0(0.00) 7(31.82) 0.012
抗生素使用史 8(47.06) 11(50.00) 1
图1 肺曲霉菌病典型胸部影像学表现。注：A：有基础疾病患者胸部CT；B：无基础疾病患者胸部CT
表2 两组肺曲霉菌病患者胸部影像学特征分析[n(%)]
影像表现 观察组(n＝17) 对照组(n＝22) P值
肺部单侧病变 13(76.47) 7(31.82) 0.010
肺结节 11(64.71) 11(50.00) 0.517
不规则高密度阴影 7(41.18) 17(77.27) 0.045
肺空洞 11(64.71) 8(36.36) 0.111
病变气道分布 5(29.41) 8(36.36) 0.740
表3 肺曲霉菌病患者的血常规、凝血功能及生化指标(中位数【第25百分位数-第75百分位数】)
变量指标 观察组(n＝17) 对照组(n＝22) P值
非正态分布数据      
WBC (109/L) 6.86(6.13～13.08) 7.13(5.29～14.07) 0.944
Neutrophils (109/L) 5.00(3.54～7.95) 5.56(3.84～11.71) 0.620
Hb(g/L) 130.00(124.00～134.00) 106.00(85.75～117.00) 0.007
PLT(109/L) 235.00(175.5～311.00) 163.50(44.00～322.25) 0.074
ESR(mm/1 h) 36.93(9.00～44.5) 57.50(10.58～74.25) 0.228
Proalbumin(g/L) 200.00(121.00～234.50) 109.00(48.50～224.25) 0.153
UREA(mmol/L) 5.58(3.85～6.30) 6.67(5.09～10.53) 0.046
CREA(μmol/L) 64.10(54.95～73.60) 73.65(51.70～103.90) 0.428
TBIL(μmol/L) 9.60(8.50～17.85) 13.30(9.90～17.90) 0.269
DBIL(μmol/L) 2.30(1.35～4.40) 2.75(1.73～5.18) 0.275
D-Dimmer(mg/L) 0.14(0.08～0.44) 0.73(0.26～1.17) 0.01
ALB(g/L) 40.90(33.15～43.75) 31.70(27.93～38.93) 0.023
正态分布数据      
FBG (g/L) 3.76±1.44 4.21±1.95 0.429
TP(g/L) 69.60±7.41 58.90±9.45 0
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