摘要目的:分析老年维持性血液透析(MHD)患者继发新型冠状病毒(COVID-19)相关肺曲霉菌病(CAPA)的临床特点和预后。方法:回顾性分析2022年12月至2023年1月就诊于首都医科大学附属北京友谊医院血液净化中心的60岁以上、重型COVID-19感染MHD患者。根据是否确诊或拟诊CAPA将患者分为CAPA组和无CAPA组，比较两组人口学资料、临床特点、诊疗情况等差异，分析老年MHD患者发生CAPA的危险因素及其对预后的影响。结果:共入组患者56例，男性42例，女性14例；年龄66.0(60.0～75.0)岁，透析龄24(66～144)个月，20例(35.7%)合并糖尿病。30 d内总体死亡率为18/56(32.1%)。12例(21.4%)在病程中发生CAPA。距离确诊重型COVID-19感染的中位数时间为16(9～23) d。突出的临床表现为咯血、胸闷、C-反应蛋白持续恶化、抗生素低反应性。8例(66.7%)死亡。年龄( OR＝1.119，95% CI：1.025～1.890)和应用糖皮质激素( OR＝6.228，95% CI：1.079～39.954)是继发CAPA的独立危险因素；CAPA与死亡独立相关( OR＝6.979，95% CI：1.455～33.476)。 结论:老年MHD重型COVID-19感染患者是继发CAPA的高危人群，预后极差；需要临床医生格外关注。

abstractsObjective:To analyze the clinical characteristics and prognosis of COVID-19-associated pulmonary aspergillosis(CAPA)in elderly patients with severe COVID-19 on maintenance hemodialysis(MHD).Methods:Data of patients aged 60 years or older with severe COVID-19 treated at the Blood Purification Center of Beijing Friendship Hospital Affiliated to Capital Medical University between December 2022 and January 2023 were retrospectively analyzed.Patients were divided into a CAPA group and a non-CAPA group, based on the existence of proven or probable CAPA.The demographics, clinical characteristics and treatment measures between the two groups were compared.Risk factors for CAPA in elderly patients on MHD and their influence on prognosis were examined.Results:A total of 56 patients were enrolled(42 men and 14 women), with an age of 66.0(60.0-75.0)years and dialysis vintage of 24(66-144)months.Twenty cases(35.7%)had concurrent diabetes.The overall 30-day mortality rate was 18/56(32.1%).Twelve cases(21.4%)developed CAPA during the course.The median time to a confirmed diagnosis of CAPA was 16(9-23)days.The prominent clinical manifestations included hemoptysis, chest tightness, continuously worsening C-reactive protein levels, and poor response to antibiotic treatment.Eight CAPA patients(66.7%)died.Increased age( OR=1.119, 95% CI: 1.025-1.890)and use of glucocorticoids( OR=6.228, 95% CI: 1.079-39.954)were independent risk factors of CAPA.CAPA was independently related to death( OR=6.979, 95% CI: 1.455-33.476). Conclusions:Elderly MHD patients with severe COVID-19 are at high risk for CAPA, which has a very poor prognosis.Clinicians should pay particularly attention to this issue.