【作者】 邱枫；

【导师】 王雪芬；

【作者基本信息】 浙江大学 ， 内科学（专业学位）， 2014， 硕士

【摘要】 目的：分析慢性阻塞性肺疾病(COPD)伴发侵袭性肺曲霉菌病(IPA)患者的临床表现及影像学特征,以加深对此类疾病的认识,提高诊疗水平。方法：对2012年1月1日至2013年12月31日于浙江大学医学院附属第一医院住院治疗的48例侵袭性肺曲霉菌病患者进行回顾性分析,比较有COPD疾病基础的患者(COPD组)与无COPD疾病基础的患者(非COPD组)之间的症状、实验室检查、影像学表现、治疗和预后。结果：48例患者中COPD组16例,非COPD组32例。两组患者均可.现为咳嗽咳痰、胸闷气急、发热、咯血痰血等。16例COPD组患者中14例(87.50%)起病时(?)·P升高,10例(62.50%)出现白细胞升高。非COPD组中25例(78.13%)起病时CRP升高,9例(28.13%)出现白细胞升高,8例(25%)白细胞、中性粒细胞减少(均为血液系统疾病患者)。两组患者肺部CT均可出现大小不一的结节、团块影、实变、空洞、磨玻璃样改变、终末气道改变、晕征以及空气新月征等。COPD组中最常见的表现为空洞(62.5%),其次为细支气管扩张和小结节(均为56.25%)；而在非COPD组中则多为大结节(56.25%)和小结节病灶(46.88%)。COPD组患者中气道侵袭患者(68.75%)明显多于非COPD组(34.38%)。COPD组患者合并IPA时团块影较非COPD组少,而树芽征、细支气管扩张、片状实变等表现较非COPD组多。结论：COPD和非COPD患者在合并IPA时,其临床表现均以发热、气急、咳嗽咳痰等为主,部分患者可出现血象、CRP升高,两组间无明显统计学差异。影像学表现上,与非COPD患者相比,COPD患者在合并IPA时小气道损害(树芽征、细支气管扩张等表现)、小片状实变及小病灶(如小片状实变、小结节等)内空洞形成等较常见,更易沿气道侵袭,而团块样病灶较少出现。更多还原

【Abstract】 Objective:To deeper the understanding of this disease and improve the diagnostic level by analyzing the clinical manifestation and imaging feature of invasive pulonary aspergillosis in chronic obstructive pulmonary disease patients.Method:We reviewd the clinical date of48admissions who were treated in1st Affiliated Hospital,College of Medicine,Zhejiang University from Jan2012to Dec2013. We analyse the differences between COPD and non-COPD patients.Clinical manifestation, laboratory examination,imaging feature,treatment and prognosis are all included.ResultsAmong the48invasive pulmonary aspergillosis patients,16patients are COPD patients. The two groups have similar clinical manifestation,such as cough,sputum, fever, chest tightness, dyspnea,hemoptysis.In COPD groups,87.50%(14/16) patients CRP increased when new symptoms occour,62.50%(10/16) patients have higher WBC count.In non-COPD group,78.13%(25/32) patients initial CRP rose,28.13%(9/32) patients existed leukocytosis,8patients (25%) are Leukopenia and neutropenia (all suffering from hematological diseases). Imaging signs such as nodules, consolidation-or-mass, ground glass opacity, cavity, terminal airway lesions,halo sign, air crescent sign can be found in both groups.Cavity is the most common sign in the COPD group (62.5%),followed by bronchiectasis in small airway (56.52%) and micronodules (56.52%).In the other group, the first two sign are respectively macronodules(56.25%)and micronodules(46.88%).Airway-invasive form is obviously more common in COPD patients (68.75%) than non-COPD patients (34.38%).Mass is not so common in COPD patients with IPA (6.25%) compared with the other group(34.38%). While the signs of terminal airway lesions,including bronchiectasis and tree-in-bud,are more frequent.Conclusion:When combined with IPA,the COPD patients have similar clinical manifestation to non-COPD patients.The maily manifestation includes fever, cough,sputum, chest tightness, dyspnea,hemoptysis.In some patients CRP and WBC can rise.There is no statistical difference between the two groups. Invasive pulmonary aspergillosis in COPD patients are more inclined to airway-invasive. The signs of terminal airway lesions and cavity in small objective are more common in these patients.Mass occours less frequently than other patients.更多还原