目的:评估慢性肺曲霉病(CPA)患者的临床特征和治疗结果,并确定疾病复发的危险因素。
方法:共43例CPA患者(平均±SD年龄:61.4±10.5岁,83.7%为男性)纳入本回顾性研究。人口统计数据,临床和疾病相关特征,支气管肺泡灌洗(BAL)样品中的半乳甘露聚糖(GM)测试阳性,组织病理学诊断,影像学(CT)发现和CPA形式,抗真菌治疗,记录复发率和复发时间。
结果:慢性阻塞性肺疾病(COPD;76.7%)是主要的诱发因素,曲霉菌结节(37.2%)是最普遍的CPA形式。在89.7%(35/39)的BAL样品中注意到GM测试阳性。伏立康唑治疗的中位持续时间为180天。14.0%的患者出现CPA复发,而结核病后遗症合并症(66.7%vs.16.2%,p=0.02)和轻度免疫抑制性疾病(100.0%vs.51.4%,p=0.032)在复发患者中明显更常见那些没有复发的。单纯性曲霉菌瘤患者复发率为50.0%(6例患者中有3例),在其他注册会计师表格中,范围为0.0%至25.0%。治疗时间和复发时间为70-270天和1.1-37个月,分别在单纯性曲霉菌中,虽然它们的范围为150-180天和30-43.3个月,分别以其他CPA形式。
结论:我们的研究结果表明,在易感疾病患者的鉴别诊断中考虑CPA的重要性,强调结核病后遗症,免疫抑制性障碍和某些CPA形式在抗真菌治疗持续时间较短的情况下管理(即,单纯性曲霉菌瘤)是CPA复发的潜在危险因素。
OBJECTIVE: To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence.
METHODS: A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded.
RESULTS: Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms.
CONCLUSIONS: Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.