甲型流感合并侵袭性肺曲霉病42例 临床分析

Clinical Analysis of 42 Cases of Influenza A Complicated by Invasive Pulmonary Aspergillosis

摘要: 目的：探讨甲型流感病毒感染合并侵袭性肺曲霉病的临床特征，提高临床医生对该病的认识。方法：回顾性收集2024年10月至2025年2月河北省人民医院收治的42例甲型流感合并侵袭性肺曲霉病患者的临床基本资料，分析其人口学特征、临床表现、合并症、实验室及影像学检查、抗真菌治疗方案及临床结局。结果：42例患者平均年龄为68岁(67.6 ± 13.9)，男性32例(76.2%)，女性10例(23.8%)，死亡率16.7% (7例)。病原学以烟曲霉(83.3%)和黄曲霉(57.1%)为主，多表现为≥2种曲霉菌混合感染(45.2%)，易合并其他病原体感染(59.5%)。合并基础疾病36例(85.7%)，其中高血压15例(35.7%)、慢性阻塞性肺病13例(31.0%)、糖尿病10例(23.8%)。临床症状以咳嗽(39例，92.9%)、咳痰(38例，90.5%)、发热(31例，73.8%)、呼吸困难(24例，57.1%)和乏力(17例，40.5%)多见。实验室检查常合并贫血(28例，66.7%)、血小板减少(10例，23.8%)和低白蛋白血症(37例，88.1%)等。抗真菌治疗以伏立康唑(37例，88.1%)为主，平均疗程11天。结论：甲型流感合并侵袭性肺曲霉病患者以男性患者为主，多合并高血压、糖尿病、慢性阻塞性肺疾病等基础疾病，其临床表现及CT征象常缺乏特异性，易引起贫血、血小板减少及多器官功能损伤，需早期识别并进行规范的抗真菌治疗，以改善患者预后。

Abstract: Objective: To investigate the clinical characteristics of influenza A virus infection complicated by invasive pulmonary aspergillosis (IPA) and enhance clinicians’ understanding of this condition. Methods: Clinical data from 42 patients with influenza A complicated by IPA admitted to Hebei Provincial People’s Hospital between October 2024 and February 2025 were retrospectively collected. Data included demographics, clinical manifestations, comorbidities, laboratory and imaging findings, antifungal treatment regimens, and clinical outcomes. Results: The mean age of the 42 patients was 68 years (67.6 ± 13.9). Males predominated (32 cases, 76.2%) over females (10 cases, 23.8%), with a mortality rate of 16.7% (7 cases). The primary pathogens were Aspergillus fumigatus (83.3%) and Aspergillus flavus (57.1%), with mixed infections of ≥2 Aspergillus species occurring in 45.2% of cases. Co-infection with other pathogens was common (59.5%). Underlying diseases were present in 36 cases (85.7%), including hypertension (15 cases, 35.7%), chronic obstructive pulmonary disease (13 cases, 31.0%), and diabetes (10 cases, 23.8%). Frequent clinical symptoms included cough (39 cases, 92.9%), sputum production (38 cases, 90.5%), fever (31 cases, 73.8%), dyspnea (24 cases, 57.1%), and fatigue (17 cases, 40.5%). Laboratory abnormalities often included anemia (28 cases, 66.7%), thrombocytopenia (10 cases, 23.8%), and hypoalbuminemia (37 cases, 88.1%). Voriconazole was the primary antifungal agent (37 cases, 88.1%), with a mean treatment duration of 11 days. Conclusion: Patients with influenza A complicated by IPA are predominantly male and often have underlying conditions such as hypertension, diabetes, and chronic obstructive pulmonary disease. Clinical manifestations and CT findings often lack specificity. The condition is prone to causing anemia, thrombocytopenia, and multi-organ dysfunction. Early identification and standardized antifungal treatment are essential to improve patient prognosis.