继发于肺癌的侵袭性气管支气管曲霉病临床分析（附8例报告）

Clinical analysis of invasive trancheobronchial aspergillosis secondary to lung cancer (8 cases)

摘要:

目的 探讨侵袭性气管支气管曲霉病（ITBA）的临床特点。方法 回顾性分析2016年11月－2018年11月苏州大学附属第一医院呼吸与危重症医学科经病理确诊的8例继发于肺癌的ITBA患者的临床资料，包括病因、临床表现、胸部CT表现、气管镜下表现、感染部位、血清和灌洗液半乳甘露聚糖（galactomannan，GM）试验、治疗过程和预后。结果 ①8例ITBA患者均接受过全身化疗，7例接受过放疗（包括后装放疗及I¹²⁵粒子植入），2例行气道内支架置入；②ITBA主要症状：咳嗽咳痰8例（100.0%）、胸闷5例（62.5%）、痰中带血2例（25.0%），发热1例（12.5%）；胸部CT表现：无明显变化4例（50.0%）、病变部位气管壁增厚或管腔狭窄2例（25.0%）、阻塞性肺不张2例（25.0%）；气管镜下表现：伪膜型3例（37.5%）、阻塞型2例（25.0%）、溃疡型3例（37.5%）；GM试验：血清GM试验阳性率为28.6%（2/7），平均值（0.37±0.21）；灌洗液GM试验阳性率为100.0%（7/7），平均值（4.27±2.14），灌洗液GM试验阳性率和平均值均高于血清（ ² = 7.78，P = 0.005；t = 4.79，P = 0.003）；③经伏立康唑等抗曲霉菌治疗后，1例痊愈，7例死亡，总生存时间为（4.07±3.31）个月。结论 ①肺癌、化疗、放疗、气道支架置入均可能成为ITBA的高危因素；②ITBA临床及影像学表现缺乏特异性、诊断困难、预后差，纤维支气管镜在ITBA的诊断及治疗过程中仍具有不可替代的作用；③灌洗液GM试验在诊断ITBA方面较血清具有更高的敏感性，值得进一步研究。

Abstract:

Objective To study the clinical characteristics of invasive trancheobronchial aspergillosis（ITBA）.Methods The clinical data of 8 ITBA patients secondary to lung cancer, who were pathologically diagnosed from November 2016 to November 2018 were studied retrospectively, the etiologies, clinical manifestations, CT imagings, bronchoscopic findings, serum and BALF GM tests, treatments and prognosis were included.Results All the 8 ITBA patients received systemic chemotherapy, 7 patients received radiotherapy (including brachytherapy and I125 implantation), and 2 patients received airway stent implantation; Main symptoms of ITBA: cough and sputum in 8 cases (100.0%), chest tightness in 5 cases (62.5%), hemoptysis in 2 cases (25.0%), fever in 1 case (12.5%); CT imagings: 4 cases (50.0%) had no significant change, 2 cases (25.0%) had thickened airway wall or stenosis, and 2 cases (25.0%) had obstructive atelectasis. Bronchoscopic finding: 3 cases (37.5%) were pseudomembranous forms, 2 cases (25.0%) were obstructive forms, and 3 cases (37.5%) were ulcerative forms; GM test: the positive rate of serum GM test was 28.6%（2/7）, with an average value of （0.37 ± 0.21）,The positive rate of BALF GM test was 100.0% (7/7), with an average value of (4.27 ± 2.14), which was higher than that of serum ( ² = 7.78, P = 0.005; t = 4.79, P = 0.003); After anti-aspergillosis treatment such as voriconazole, 1 patient recovered and 7 died, with an average total survival time of (4.07 ± 3.31) months.Conclusion Lung cancer, chemotherapy, radiotherapy and airway stent implantation may be the high risk factors for ITBA; There is no specificity in clinical and imaging manifestations of ITBA. So it is quite difficult to diagnosis and it has a poor prognosis. Bronchoscopy still plays an irreplaceable role in the diagnosis and treatment of ITBA; The BALF GM test is more sensitive than serum in the diagnosis of ITBA, which is worthy of further study.