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目的分析老年重症慢性阻塞性肺病(COPD)并发侵袭性肺曲霉病(IPA)临床特点。方法回顾性分析10例老年重症COPD并发IPA患者的临床资料。结果本组患者均有全身使用糖皮质激素及广谱抗生素史,治疗过程中均有喘息及呼吸困难加重,确诊1例,临床诊断9例。胸部影像学短期内进展明显,可有两肺多发斑片渗出、单发或多发结节伴周围渗出、支气管壁增厚伴狭窄等影像特点。伏立康唑、卡泊芬净或两药联合抗真菌治疗后5例好转,5例死亡。结论老年重症COPD并发IPA的临床症状缺乏特异性,病死率高,且确诊困难。尽早开始抗曲霉经验性治疗以改善COPD并发IPA患者的预后。
Objective To analyze the clinical features of elderly patients with severe chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA). Methods The clinical data of 10 elderly patients with severe COPD complicated with IPA were retrospectively analyzed. Results All patients had systemic glucocorticoid and broad-spectrum antibiotics history. All patients had wheezing and dyspnea during the course of treatment. One patient was diagnosed and 9 were diagnosed clinically. Chest imaging obvious short-term progress, there may be multiple lung multiple exudate, single or multiple nodules with peripheral exudation, bronchial wall thickening with stenosis and other imaging features. Voriconazole, caspofungin or two drugs combined antifungal therapy in 5 patients improved, 5 patients died. Conclusion The clinical symptoms of elderly severe COPD complicated with IPA lacks specificity, and the mortality rate is high, and the diagnosis is difficult. As early as possible, Aspergillus initial treatment to improve the prognosis of COPD patients with IPA.