侵袭性肺真菌病的支气管镜表现及介入治疗效果

Bronchoscopic manifestations and interventional treatment effect of invasive pulmonary fungal disease

摘要:

目的 探讨侵袭性肺真菌病（IPFD）的支气管镜表现，并评估介入治疗的安全性和疗效。方法 回顾性分析2018年5月12日－2025年5月12日于该院行支气管镜检查的35例IPFD患者的临床资料，观察IPFD的支气管镜表现及介入治疗效果。结果 共收集35例患者临床资料。其中，男22例，女13例，患者年龄（53±14）岁。基础疾病包括：血液系统恶性肿瘤10例，长期应用糖皮质激素者5例，2型糖尿病者4例，肺部恶性肿瘤2例，器官移植1例。胸部CT显示：肺部病变累及单肺叶者19例，累及多肺叶者16例。支气管镜下表现主要为：黏膜充血水肿29例（82.9%）、坏死物堵塞管腔22例（62.9%）、大量黏稠脓性分泌物17例（48.6%）、支气管部分狭窄或闭塞16例（45.7%）、黏膜坏死9例（25.7%）、黏膜出血5例（14.3%）、真菌球3例（8.6%）。其中，32例（91.4%）接受全身性抗真菌治疗，17例（48.6%）接受支气管镜局部两性霉素B灌注治疗，10例（28.6%）采用活检钳钳除病灶，6例（17.1%）采用冷冻探头冻取病灶，4例（11.4%）接受氩气刀治疗。28例（80.0%）临床症状明显改善，肺部影像学病灶缩小或消退；4例（11.4%）病灶稳定；3例（8.6%）未完成治疗。结论 IPFD多见于免疫抑制宿主，支气管镜常表现为：坏死物堵塞管腔、伴脓性分泌物、支气管管腔狭窄和局部黏膜充血水肿或坏死。全身抗真菌药物联合支气管镜下介入治疗，安全性高，且疗效好。

Abstract:

Objective To explore the bronchoscopic manifestations of invasive pulmonary fungal disease (IPFD) and evaluate the safety and efficacy of interventional therapy effect.Methods A retrospective analysis was conducted on the clinical data of 35 patients with IPFD who underwent bronchoscopy from May 12, 2018 to May 12, 2025 to observe the bronchoscopic manifestations and interventional therapy of IPFD.Results 35 patients’ clinical data were collected, including 22 males and 13 females, with an age of (53 ± 14) years. The underlying diseases included: 10 cases of hematological malignancies, 5 cases of long-term use of glucocorticoids, 4 cases of type 2 diabetes, 2 cases of lung malignancies, and 1 case of organ transplant patient. Chest CT showed that there were 19 cases of lung lesions involving a single lobe and 16 cases involving multiple lobes. The main manifestations under bronchoscopy were 29 cases with mucosal hyperemia and edema (82.9%), 22 cases with necrotic substances blocking the lumen (62.9%), 17 cases with a large amount of viscous purulent secretions (48.6%), 16 cases with partial bronchial stenosis or occlusion (45.7%), 9 cases with mucosal necrosis (25.7%), 5 cases with mucosal hemorrhage (14.3%), and 3 cases with fungal globules (8.6%). Among them, 32 cases (91.4%) received systemic antifungal treatment, 17 cases (48.6%) received local amphotericin B perfusion treatment by bronchoscopy, 10 cases (28.6%) had the lesion removed by biopsy forceps, 6 cases (17.1%) had the lesion frozen by cryoprobe, and 4 cases (11.4%) received argon plasma coagulation treatment. The clinical symptoms of 28 cases (80.0%) improved significantly, and the lung imaging lesions shrank or regressed. Four cases (11.4%) had stable lesions. Three cases (8.6%) did not complete the treatment.Conclusion IPFD is more common in immunosuppressed hosts, bronchoscopy often presents with necrotic substances blocking the lumen, accompanied by purulent secretions, bronchial lumen stenosis, local mucosal hyperemia, edema or necrosis. Systemic antifungal drugs combined with interventional therapy under bronchoscopy have high safety and good therapeutic effects.