结核后慢性肺曲霉病患者的临床特征及影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2024.05.005

摘要/Abstract

摘要： 目的分析结核后慢性肺曲霉病（chronic pulmonary aspergillosis,CPA）患者的临床特征及相关影响因素,以提高临床医生对结核后CPA的认识。方法选取2021年4月1日至2023年4月30日深圳市第三人民医院住院部收治的59例确诊CPA的陈旧性肺结核患者作为观察组（CPA组）,选取同期不伴有肺部真菌感染的陈旧性肺结核患者118例作为对照组（非CPA组）,比较两组患者的临床指标。通过单因素和多因素Logistic回归分析,探究结核后CPA的发病影响因素,并构建结核后患者发生CPA的预测模型。结果病原学检出曲霉菌阳性46例,阳性率78.0%（46/59）,烟曲霉占比80.5%（37/46）。单因素分析显示,CPA组消瘦患者（BMI<18.5kg/m²）比例显著高于非CPA组（P<0.05）;CPA组患者合并毁损肺、慢性阻塞性肺疾病、支气管扩张症比例均高于非CPA组（P<0.05）;CPA组患者比非CPA组既往抗结核疗程更长（P<0.05）;CPA组咳嗽、咳痰、咯血、气促及体重下降患者比例高于非CPA组（P<0.05）;CPA组影像学表现为空洞、空气新月征、肺实变及团块影比例高于非CPA组,肺结节影比例低于非CPA组（P<0.05）;CPA组低蛋白血症患者比例、C反应蛋白、红细胞沉降率均高于非CPA组（P<0.05）,血红蛋白、血清白蛋白水平低于非CPA组（P<0.05）。多因素Logistic回归分析显示,BMI（OR=0.865,95%CI：0.767~0.976,P=0.018）和毁损肺（OR=5.833, 95%CI: 1.922~17.698, P=0.002）是结核后CPA的独立影响因素。结论结核后CPA中烟曲霉为主要病原菌;以咳嗽、咳痰、咯血、体重下降、气促为主要症状;多表现为消瘦,低蛋白血症;C反应蛋白水平、红细胞沉降率升高;肺部影像学病灶形态以实变及团块影为主,病灶特征以空洞、空气新月征为主要表现;毁损肺、低BMI是结核后CPA的影响因素。

关键词: 结核后肺疾病, 慢性肺曲霉病, 临床特征, 影响因素

Abstract: Objective To analyze the clinical characteristics and influence factors of chronic pulmonary aspergillosis (CPA) after tuberculosis to improve clinicians' understanding of post-tuberculosis CPA. Method From April 1, 2021, to April 30, 2023, 59 patients with chronic pulmonary aspergillosis who had a history of pulmonary tuberculosis were treated in the inpatient department of Third People's Hospital as the observation group (CPA group), and 118 patients with old pulmonary tuberculosis who did not have pulmonary fungal infection in the same period were selected as the control group (non-CPA group), and the clinical indicators of the two groups of patients were compared. The influence factors for the onset of CPA were analyzed by univariate and multivariate logistic regression analysis. Result Among 59 CPA patients, aspergillus fumigatus accounted for 80.5% (37/46). Univariate analysis showed that the proportion of lean patients in the CPA group was significantly higher than that in the non CPA group (P<0.05). The proportion of CPA combined with lung damage, chronic obstructive pulmonary disease, or bronchiectasis was higher in the non CPA group (P<0.05). The CPA group had a longer history of anti-tuberculosis treatment compared to the non CPA group (P<0.05). The proportion of patients with cough, sputum, hemoptysis, shortness of breath, or weight loss in the CPA group was higher than that in the non CPA group (P<0.05); The imaging manifestations of the CPA group were higher in terms of cavities, air crescent sign, consolidation, and mass shadows than those in the non CPA group; while the proportion of nodular shadows was lower than that in the non CPA group (P<0.05). The proportion of patients with hypoproteinemia, abnormal C-reactive protein, or erythrocyte sedimentation rate in the CPA group was higher compared to the non CPA group (P<0.05). The levels of hemoglobin and serum albumin in the CPA group were lower than those in the non CPA group (P<0.05). Multivariate logistic regression analysis showed that BMI (OR=0.865, 95% CI:0.767-0.976, P=0.018) and destroyed lung (OR=5.833, 95% CI:1.922-17.698, P=0.002) were independent influencing factors of post-tuberculosis CPA. Conclusion Aspergillus fumigatus is the main pathogen in post-tuberculosis CPA. The main symptoms include cough, sputum, hemoptysis, weight loss, and shortness of breath. Clinical manifestations include emaciation and hypoalbuminemia; elevated C-reactive protein and erythrocyte sedimentation rate. The pulmonary imaging lesions are mainly characterized by consolidation and mass shadows, with lesions characterized by cavities and air crescent signs as the main manifestations; Tuberculous lesions and low BMI are independent influence factors for chronic pulmonary aspergillosis after tuberculosis.

Key words: Post-tuberculosis lung disease, Chronic pulmonary aspergillosis, Clinical features, Influence factors

中图分类号:

R521

曾坚, 王瑾, 方木通, 曾剑锋, 卢水华, 黄河. 结核后慢性肺曲霉病患者的临床特征及影响因素分析[J]. 新发传染病电子杂志, 2024, 9(5): 25-30.

Zeng Jian, Wang Jin, Fang Mutong, Zeng Jianfeng, Lu Shuihua, Huang He. Analysis of clinical features and influence factors of patients with post-tuberculosis chronic pulmonary aspergillosis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(5): 25-30.

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