关键词: 结核,肺, 曲霉菌病, 疾病特征

Abstract:

Objective: To analyze the clinical characteristics of pulmonary tuberculosis combined with chronic pulmonary aspergillosis, in order to improve the diagnosis and treatment capabilities of clinical doctors in China. Methods: A retrospective study was conducted on 220 patients with pulmonary tuberculosis complicated with chronic pulmonary aspergillosis admitted to Wuhan Pulmonary Hospital in 2022. Clinical data of these patients such as patient gender, age, past medical history, symptoms, course of disease, imaging findings and classification, laboratory tests and pathological results, treatment, outcomes, and follow-up were collected and their clinical characteristics were analyzed for their clinical characteristics. Results: Among 220 patients, 21 (9.55%) were complicated with active pulmonary tuberculosis, and 199 (90.45%) had post tuberculosis pulmonary diseases, of which 139 (63.18%) were complicated with other basic diseases, 49 (22.27%) with chronic obstructive pulmonary disease and 44 (20.00%) with diabetes. The most common type was chronic cavitary pulmonary aspergillosis in 120 cases (54.55%). Clinical symptoms included 207 cases of cough (94.09%), 178 cases of sputum (80.91%), and 126 cases of hemoptysis (57.27%). Laboratory tests mainly showed 112 cases of anemia (50.91%), 102 cases of decreased albumin (46.36%), 151 cases of erythrocyte sedimentation rate (68.64%), and 117 cases of elevated hCRP (53.18%). Chest CT often showed involvement of 189 cases (85.91%) of the upper lung and 162 cases (73.64%) of the right lung. Common signs included pulmonary cavities in 192 cases (87.27%), intraluminal septa in 166 cases (75.45%), pleural hypertrophy in 166 cases (75.45%), air crescent sign in 147 cases (66.82%), pulmonary fibrosis in 129 cases (58.64%), and emphysema in 121 cases (55.00%). The sputum or bronchoalveolar lavage fluid aspergillus nucleic acid test, serum aspergillus IgG test, and bronchoalveolar lavage fluid galactomannan antigen test showed a high positive rate for the diagnosis of chronic pulmonary aspergillosis, with rates of 54.09% (119/220),68.18% (150/220),and 60.91% (134/220), respectively. 80.77% (126/156) of the rate of stable condition was higher in the antifungal treatment group than in the non-antifungal treatment group 40.35% (23/57),without antifungal treatment (χ²=32.447,P=0.001). A total of 45 patients (30.20%) experienced recurrence during a one-year follow-up, with a recurrence rate of 19.84% (25/126) in the antifungal treatment group, which was much lower than 89.96% (20/23) in the non antifungal treatment group (χ²=41.561,P=0.001). Conclusion: Pulmonary tuberculosis, especially post tuberculosis pulmonary diseases, is prone to comorbidity with chronic pulmonary aspergillosis. Recurrent coughing, sputum production, hemoptysis, and chest CT showing pulmonary cavities and pleural hypertrophy should raise suspicion of comorbidity with chronic pulmonary aspergillosis. It is recommended to conduct serum aspergillosis IgG test and/or bronchoalveolar lavage fluid galactomannan antigen test or aspergillosis nucleic acid test to promptly confirm the diagnosis. Full course antifungal treatment and surgical treatment are effective treatment methods for treating chronic pulmonary aspergillosis.

Key words: Tuberculosis, pulmonary, Chronic pulmonary aspergillosis, Clinical characteristics