矽肺并发曲霉菌病2例报告
Two Case Reports of Pneumosilicosis Complicated with Aspergillosis
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摘要:
目的 探讨矽肺并发曲霉菌病早期诊断的有效方法。 方法 回顾性分析2012年1月-2013年1月在杭州市红十字会医院职业病科住院的2例矽肺并发曲霉菌患者的诊疗过程,包括高危因素的评价、实验室检查:血总免疫球蛋白(IgE)、血1, 3β-D葡聚糖检测(G实验)及半乳甘露聚糖抗原检测(GM实验),痰培养等,以及胸部CT的特征性表现等。 结果 长期营养不良、广谱抗生素及糖皮质激素使用等,是并发肺部真菌病的高危因素,血IgE升高、G实验及GM实验阳性,胸部CT的"新月征"等均是其诊断的重要辅助方法。 结论 矽肺合并多种高危因素者,辅助相应的实验室检查,结合胸部CT特征性表现,综合分析病情,有助于早期发现矽肺并发肺部曲霉菌感染。 Abstract:Objective To explore an effective method for early diagnosis of pneumosilicosis complicated with aspergillosis. Methods Two cases of pneumosilicosis complicated with aspergillosis registered to the occupational disease department of Hangzhou Red Cross Hospital from 2012 to 2013 were analyzed, including the evaluation of high risk factors, lab oratory tests of serum total immunoglobulin (IgE), blood 1, 3 β-D glucan assay (G test) and galactomannan antigen (GM test), sputum culture, as well as chest CT features. Results Long-term malnutrition, broad-spectrum antibiotics, and glucocorticoid were high risk factors of inducing pneumosilicosis complicated with aspergillosis. The increases of serum IgE, positive G test and GM test, and the "crescent sign" shown in the chest CT scan image were important auxiliary indicators for diagnosis. Conclusion Appropriate lab oratory tests and chest CT features are helpful to the early diagnosis of pneumosilicosis complicated with pulmonary aspergillosis.
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