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【Objective】 by chest CT findings of 54 patients with pulmonary aspergillosis host factors, GM test, microbiological testing, histopathological examination, treatment methods, statistical analysis of risk factors for death, improve clinicians invasive and parasitic pulmonary aspergillosis The vigilance of the epidemiological situation awareness and early diagnosis is correct, scientifically formulated pulmonary aspergillosis diagnostic process, treatment options to improve the prognosis of severe or difficult lung infection provides a theoretical basis. [Methods This study was a retrospective cohort study. Zhongshan Hospital, Fudan discharged history data for November 2002 - March, including organ transplantation, thoracic surgery, respiratory medicine to discuss difficult cases records, as well as microbial Room, Department of Pathology, inspection records, register, search for suspected pulmonary aspergillosis disease. According to the 2005 European cancer research and treatment organizations and fungi Study Group (EORTC / MSG) consensus on the draft Ⅵ diagnosis of invasive fungal infections, and invasive pulmonary fungal infections in China in 2006, the Working Group invasive pulmonary fungal infection diagnostic criteria and treatment principle (draft) collected confirmed the clinical diagnosis of pulmonary aspergillosis. Making questionnaire to collect relevant information is as follows: (1) demographic data; (2) The diagnosis is based on (host factors, clinical features, chest CT, microbiological examination GM trials, pathological examination); (3) treatment options (drug treatment, surgery) and prognosis. SPSS11.5 statistical software for analysis. Normal distribution of measurement data to describe the mean ± standard deviation, a non-normal distribution of measurement data to describe the median. Count data the constituent ratio n (%) to describe using χ ~ 2 test. The univariate analysis of risk factors for death of invasive pulmonary aspergillosis, the normal distribution of measurement data described by the standard deviation of the average soil t test, count data χ ~ 2 test. Screened univariate analysis significant risk factors. Independent risk factor for multi the factors using Logisti regression analysis to determine the death. [Results] (1) a total of 54 cases of pulmonary aspergillosis patients, diagnosed 28 cases, clinical diagnosis of 26 cases. Age 23-81y, mean 51y. Male 35 cases (64.8%). (2) invasive pulmonary aspergillosis in 36 patients (66.7%) were diagnosed in 2004 and 2007, the number of cases increased year by year, Aspergillus fumigatus and 80% (12/15) as the main pathogens. Host factors in 32 cases (88.9%), 10 cases (27.8%) only four cases (11.1%) of the underlying disease, without any immunocompromised host factors, or COPD. 28 cases (77.8%) patients, CT examination, mainly as follows: nodules 22 cases (78.6%), clumps of 14 cases (50%), the wedge consolidation of nine cases (32.1%), halo sign nine cases (32.1% ) crescent sign in 3 cases (10.7%), empty 22 cases (78.6%). Sputum fungal culture positive rate was 52.8% (19/36), the BALF of fungal culture positive rate was 55.6% (5/9), the GM test positive rate (≥ 0.5) and 80% (16/20), positive pathological examination of lung tissue rate of 88.3% (10/12). The initial diagnosis misdiagnosis rate as high as 63.9% (23/36). Initial antifungal therapy effective rate of 48.6% (17/35). Overall case fatality rate 30.6% (11/36), which after transplantation, COPD, sputum fungal culture-positive patients mortality were 71.4% (5/7), 100% (6/6), 57.9% (11/19) , these three risk factor for death (p <0.05). The death group older than the survival group (p <0.05). (3) 18 patients diagnosed parasitic pulmonary aspergillosis patients, 6 patients (33.3%), other lung underlying disease. Hemoptysis in 15 patients (88.3%). The niger ball associated with the the crescent sign nine cases (50%). GM trials, four cases were positive. Initial misdiagnosis rate of 83.3% (15/18), 7 patients (38.9%) were not taken into account in the preoperative pulmonary aspergillosis. Telephone follow-up after surgery in 11 cases, the cure rate was 90.9% (10/11), 8 patients unused antifungal agents, including one case of postoperative recurrence of bronchial stump fistula. [Conclusion] (1) the invasive parasitic pulmonary aspergillosis, there are large differences in host factors, clinical features, CT findings, treatment and prognosis. (2) In recent years invasive pulmonary aspergillosis diagnosis increasing trend in the number of cases, as a major pathogen Aspergillus fumigatus, chronic lung disease such as COPD can be used alone as a host of factors. (3) CT manifestations of invasive pulmonary aspergillosis, mainly lungs distribution of nodules, lumps, and more with the empty, typical performance \%, the histopathological diagnosis difficult in some cases. (4) 30.6% of the mortality of invasive pulmonary aspergillosis, initial antifungal therapy effective rate of 48.6%, after transplantation, COPD sputum culture detection of Aspergillus older as risk factors for death. (5) parasitic pulmonary aspergillosis often without underlying disease, cavitary lung disease caused by the minority with tuberculosis and bronchiectasis. (6) hemoptysis (88.3%) are the most common symptoms of parasitic pulmonary aspergillosis. CT showed solitary nodules, only half of the spherical lesions with crescent sign. Preoperative diagnosis of 11 cases (61.1%). (7) surgery is the most common parasitic pulmonary aspergillosis treatment, the cure rate was 90.9% (10/11). Alone or the postoperative the antifungal therapeutic value, pending further study.
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