中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2014年
9期
677-681
,共5页
牟向东%余进%聂立功%程渊%王广发
牟嚮東%餘進%聶立功%程淵%王廣髮
모향동%여진%섭립공%정연%왕엄발
肺曲霉病%侵袭性肺曲霉病%曲霉菌病,变应性支气管肺%混合型肺曲霉病
肺麯黴病%侵襲性肺麯黴病%麯黴菌病,變應性支氣管肺%混閤型肺麯黴病
폐곡매병%침습성폐곡매병%곡매균병,변응성지기관폐%혼합형폐곡매병
Pulmonary aspergilloma%Invasive pulmonary aspergillosis%Aspergillosis,allergic bronchopulmonary%Mixed types of pulmonary aspergillosis
目的 探讨混合型肺曲霉病(MTPA)的临床特点,提高对该病的诊治水平.方法 回顾性分析2010年11月至2012年11月北京大学第一医院收治的3例MTPA的临床特点.以“侵袭性肺曲霉病”、“肺曲霉球”及“变应性支气管肺曲霉病”两两组合为检索词,通过万方数据库和中国期刊全文数据库进行检索,以“混合型肺曲霉病”为检索词均未检索到相关文献;以“invasive pulmonaryaspergillosis”、“pulmonary aspergilloma”及“allergic bronchopulmonary aspergillosis”两两组合为检索词,在PubMed数据库检索到国外3篇文献,均为个案报道;以“mixed types of pulmonary aspergillosis”为检索词未检出相关文献.结果 3例MTPA患者中,肺曲霉球合并侵袭型肺曲霉病(IPA)、变应性支气管肺曲霉病(ABPA)合并IPA及肺曲霉球合并ABPA各1例.例1和例2的BALF培养为烟曲霉,例3手术肺病理为曲霉球.例1应用两性霉素B等治疗,例2应用伊曲康唑和糖皮质激素等治疗,例3应用伏立康唑和糖皮质激素吸入等治疗,同时行肺曲霉球切除术.例1和例2患者均治疗无效而死亡,例3患者明显好转.药敏试验结果显示,例1两性霉素B耐药,例2伊曲康唑耐药.文献复习显示国内外尚无MTPA的概念,国外仅有3例相关个案报道.结论 MTPA是一个新概念,其病情相对复杂和严重,并可能存在曲霉耐药,需尽早采取敏感的抗真菌药物治疗为基础的综合措施.
目的 探討混閤型肺麯黴病(MTPA)的臨床特點,提高對該病的診治水平.方法 迴顧性分析2010年11月至2012年11月北京大學第一醫院收治的3例MTPA的臨床特點.以“侵襲性肺麯黴病”、“肺麯黴毬”及“變應性支氣管肺麯黴病”兩兩組閤為檢索詞,通過萬方數據庫和中國期刊全文數據庫進行檢索,以“混閤型肺麯黴病”為檢索詞均未檢索到相關文獻;以“invasive pulmonaryaspergillosis”、“pulmonary aspergilloma”及“allergic bronchopulmonary aspergillosis”兩兩組閤為檢索詞,在PubMed數據庫檢索到國外3篇文獻,均為箇案報道;以“mixed types of pulmonary aspergillosis”為檢索詞未檢齣相關文獻.結果 3例MTPA患者中,肺麯黴毬閤併侵襲型肺麯黴病(IPA)、變應性支氣管肺麯黴病(ABPA)閤併IPA及肺麯黴毬閤併ABPA各1例.例1和例2的BALF培養為煙麯黴,例3手術肺病理為麯黴毬.例1應用兩性黴素B等治療,例2應用伊麯康唑和糖皮質激素等治療,例3應用伏立康唑和糖皮質激素吸入等治療,同時行肺麯黴毬切除術.例1和例2患者均治療無效而死亡,例3患者明顯好轉.藥敏試驗結果顯示,例1兩性黴素B耐藥,例2伊麯康唑耐藥.文獻複習顯示國內外尚無MTPA的概唸,國外僅有3例相關箇案報道.結論 MTPA是一箇新概唸,其病情相對複雜和嚴重,併可能存在麯黴耐藥,需儘早採取敏感的抗真菌藥物治療為基礎的綜閤措施.
목적 탐토혼합형폐곡매병(MTPA)적림상특점,제고대해병적진치수평.방법 회고성분석2010년11월지2012년11월북경대학제일의원수치적3례MTPA적림상특점.이“침습성폐곡매병”、“폐곡매구”급“변응성지기관폐곡매병”량량조합위검색사,통과만방수거고화중국기간전문수거고진행검색,이“혼합형폐곡매병”위검색사균미검색도상관문헌;이“invasive pulmonaryaspergillosis”、“pulmonary aspergilloma”급“allergic bronchopulmonary aspergillosis”량량조합위검색사,재PubMed수거고검색도국외3편문헌,균위개안보도;이“mixed types of pulmonary aspergillosis”위검색사미검출상관문헌.결과 3례MTPA환자중,폐곡매구합병침습형폐곡매병(IPA)、변응성지기관폐곡매병(ABPA)합병IPA급폐곡매구합병ABPA각1례.례1화례2적BALF배양위연곡매,례3수술폐병리위곡매구.례1응용량성매소B등치료,례2응용이곡강서화당피질격소등치료,례3응용복립강서화당피질격소흡입등치료,동시행폐곡매구절제술.례1화례2환자균치료무효이사망,례3환자명현호전.약민시험결과현시,례1량성매소B내약,례2이곡강서내약.문헌복습현시국내외상무MTPA적개념,국외부유3례상관개안보도.결론 MTPA시일개신개념,기병정상대복잡화엄중,병가능존재곡매내약,수진조채취민감적항진균약물치료위기출적종합조시.
Objective To describe the clinical features of mixed types of pulmonary aspergillosis (MTPA),and therefore to improve the diagnosis and treatment of MTPA.Methods This study retrospectively analyzed 3 patients with MTPA in Peking University First Hospital from November 2010 to 2012." Invasive pulmonary aspergillosis (IPA),pulmonary aspergilloma,allergic bronchopulmonary aspergillosis (ABPA)" were used as the Chinese and English keywords,to search the literatures from Wanfang database and Pubmed database until to May 2014.Results There were 3 patients with MTPA,respectively with aspergilloma and IPA (patient 1),ABPA and IPA (patient 2),aspergilloma and IPA (patient 3).The cultures of respiratory secretions of the patients all yielded A.fumigatus.Patient 1 was treated by amphotericin B; Patient 2 was treated by intravenous itraconazole and glucocorticoid; Patient 3 was treated by oral voriconazole and inhaled corticosteroid,and the aspergilloma was surgically removed at the same time.Eventually,patients 1 and 2 died,while the symptoms of patient 3 were significantly improved.Drug sensitivity test of A.fumigatus showed resistance to amphotericin B or itraconazole.By far there was no concept of MTPA in the literatures and there were only 3 relevant case reports.Conclusion MTPA is a new subtype of pulmonary aspergillosis,which is more complicated and severe,and perhaps with drug resistance.MTPA should be treated by comprehensive therapies on the basis of sensitive and effective antifungal drugs.
