摘要目的 探讨混合型肺曲霉病(MTPA)的临床特点,提高对该病的诊治水平.方法 回顾性分析2010年11月至2012年11月北京大学第一医院收治的3例MTPA的临床特点.以“侵袭性肺曲霉病”、“肺曲霉球”及“变应性支气管肺曲霉病”两两组合为检索词,通过万方数据库和中国期刊全文数据库进行检索,以“混合型肺曲霉病”为检索词均未检索到相关文献;以“invasive pulmonaryaspergillosis”、“pulmonary aspergilloma”及“allergic bronchopulmonary aspergillosis”两两组合为检索词,在PubMed数据库检索到国外3篇文献,均为个案报道;以“mixed types of pulmonary aspergillosis”为检索词未检出相关文献.结果 3例MTPA患者中,肺曲霉球合并侵袭型肺曲霉病(IPA)、变应性支气管肺曲霉病(ABPA)合并IPA及肺曲霉球合并ABPA各1例.例1和例2的BALF培养为烟曲霉,例3手术肺病理为曲霉球.例1应用两性霉素B等治疗,例2应用伊曲康唑和糖皮质激素等治疗,例3应用伏立康唑和糖皮质激素吸入等治疗,同时行肺曲霉球切除术.例1和例2患者均治疗无效而死亡,例3患者明显好转.药敏试验结果显示,例1两性霉素B耐药,例2伊曲康唑耐药.文献复习显示国内外尚无MTPA的概念,国外仅有3例相关个案报道.结论 MTPA是一个新概念,其病情相对复杂和严重,并可能存在曲霉耐药,需尽早采取敏感的抗真菌药物治疗为基础的综合措施.

abstractsObjective To describe the clinical features of mixed types of pulmonary aspergillosis (MTPA),and therefore to improve the diagnosis and treatment of MTPA.Methods This study retrospectively analyzed 3 patients with MTPA in Peking University First Hospital from November 2010 to 2012." Invasive pulmonary aspergillosis (IPA),pulmonary aspergilloma,allergic bronchopulmonary aspergillosis (ABPA)" were used as the Chinese and English keywords,to search the literatures from Wanfang database and Pubmed database until to May 2014.Results There were 3 patients with MTPA,respectively with aspergilloma and IPA (patient 1),ABPA and IPA (patient 2),aspergilloma and IPA (patient 3).The cultures of respiratory secretions of the patients all yielded A.fumigatus.Patient 1 was treated by amphotericin B; Patient 2 was treated by intravenous itraconazole and glucocorticoid; Patient 3 was treated by oral voriconazole and inhaled corticosteroid,and the aspergilloma was surgically removed at the same time.Eventually,patients 1 and 2 died,while the symptoms of patient 3 were significantly improved.Drug sensitivity test of A.fumigatus showed resistance to amphotericin B or itraconazole.By far there was no concept of MTPA in the literatures and there were only 3 relevant case reports.Conclusion MTPA is a new subtype of pulmonary aspergillosis,which is more complicated and severe,and perhaps with drug resistance.MTPA should be treated by comprehensive therapies on the basis of sensitive and effective antifungal drugs.