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目的 探讨儿童慢性肺曲霉菌病的诊断和治疗。方法 分析 4例儿童慢性肺曲霉菌病的表现、诊断和治疗,并复习有关文献。结果 ( 1 ) 4例均表现为长期或间断发热、咳嗽,病程3月~1年。其中 2例合并胸壁脓肿。(2)2例肺部闻及细湿啰音并肝脾肿大,另 2例肺部及其他部位检查无异常。(3)2例患儿发病前无基础疾病史, 1例患慢性肉芽肿病, 1例曾患原发性肺结核。4例患儿IgG、IgA、IgM、IgE, T细胞亚群、总补体和C3、C4、中性粒细胞数量均正常。3例四唑氮蓝试验正常, 1例异常。(4)胸部影像学表现: 4例在病程中均表现为单侧肺叶实变伴胸膜肥厚。2例病初表现为多发结节影。(5)4例痰液培养均有曲霉菌生长, 2例行肺活检,在肺组织中发现曲霉菌菌丝或孢子。2例合并胸壁脓肿者,脓液培养也有曲霉菌生长。(6)4例患儿均联合应用二性霉素B和伊曲康唑治疗, 10d~1个月症状控制。结论 对于有长期发热、咳嗽,胸部影像表现为肺叶实变伴胸膜肥厚或为结节性阴影,病情进展缓慢的儿童, 应考虑慢性肺曲霉病的可能。确诊依赖于多次痰液培养或肺组织培养或在肺组织中发现曲霉菌生长。一旦确诊,联合应用二性霉素B和伊曲康唑可使病情控制。
Objective To investigate the diagnosis and treatment of chronic pulmonary aspergillosis in children. Methods The performance, diagnosis and treatment of 4 children with chronic pulmonary aspergillosis were analyzed and reviewed. Results (1) 4 cases showed long-term or intermittent fever, cough, duration of 3 months to 1 year. Two of them had chest wall abscess. (2) 2 cases of lung smell and fine wet rales and hepatosplenomegaly, the other 2 cases of lung and other parts of the examination no abnormalities. (3) There was no history of basic disease before onset, 1 case of chronic granulomatosis and 1 case of primary pulmonary tuberculosis before onset. Four cases of IgG, IgA, IgM, IgE, T cell subsets, total complement and C3, C4, the number of neutrophils are normal. Three cases of tetrazolium blue test was normal and one case was abnormal. (4) Chest imaging findings: 4 cases showed unilateral lobular consolidation with pleural hypertrophy in the course of the disease. Two cases of early performance of multiple nodules. (5) Aspergillus growth was found in 4 cases of sputum culture, lung biopsy was performed in 2 cases, and mycoplasma or spores were found in lung tissue. 2 cases of chest wall abscess, pus culture also has Aspergillus growth. (6) 4 cases of children were combined with amphotericin B and itraconazole treatment, 10d ~ 1 month symptom control. Conclusion Chronic PCP should be considered in children with long-term fever, coughing, chest radiographs manifesting with solidified pleura with pleural thickening or nodular shadows, and slow progression of the disease. Confirmation depends on multiple sputum cultures or lung tissue cultures or aspergillus growth found in lung tissue. Once diagnosed, the combination of amphotericin B and itraconazole may cause disease control.