Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease. Methods: Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed. Results: The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated. Conclusions: CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.
目的： 分析慢性肺曲霉病(CPA)的临床表现、影像及病理特征、诊断、治疗及预后，提高对该病的认识水平。 方法： 收集2006年1月至2016年10月福建医科大学附属福州市第一医院及解放军福州总医院经肺组织活检病理确诊且符合CPA的诊断标准的肺曲霉病患者，并对相关资料进行分析。本研究为回顾性分析，采用Excel统计软件进行统计分析。 结果： 29例慢性肺曲霉病中，男17例，女12例，年龄24～75岁，平均(42±16)岁。其中合并陈旧性肺结核11例，支气管扩张8例，慢阻肺3例，糖尿病2例。临床症状以咳嗽(25例)、咳痰(18例)及咯血(15例，大咯血4例)常见。19例行血清半乳甘露聚糖试验，阳性12例，2例BALF的GM试验阳性。胸部CT示病灶多累及肺上叶(24例)，以单发空洞内含坏死灶(16例)及多发空洞内含坏死灶(10例)多见，常伴"空气新月征"(13例)。22例手术切除肺组织标本的空洞(20例)或支气管腔(2例)内含大量有隔膜的曲霉丝，但未侵入肺实质。手术治疗22例，其中完全缓解19例；死亡3例，均为慢性空洞型肺曲霉病(CCPA)；药物治疗6例，其中部分缓解4例，稳定2例；1例未治疗。 结论： CPA多发生于原有慢性肺部基础疾病的患者，影像学以单发或多发空洞内含坏死物多见。肺组织标本的空洞或支气管腔内见大量曲霉丝，但未侵入肺实质可诊断为CPA。单发曲霉球及曲霉肉芽肿病手术治愈率高，CCPA手术风险大。半乳甘露聚糖试验可用于诊断肺曲霉病。.
Keywords: Mannans; Pathology; Pulmonary aspergillosis, chronic.