目的：分析糖尿病合并侵袭性肺曲霉菌感染临床诊治过程，提高对糖尿病合并侵袭性肺曲霉菌感染的诊治水平。方法复习南昌大学第二附属医院2013年11月确诊1例糖尿病合并侵袭性肺曲霉感染患者的临床资料及国内外相关文献，对侵袭性肺曲霉菌感染危险因素、早期诊断时间、血清学、胸部影像学以及药物治疗等方面进行分析。结果患者有2型糖尿病病史，胸部CT提示两肺多发结节影，晕轮征及多发空洞，肺组织化学染色阳性，肺组织发现曲霉菌丝，明确诊断为侵袭性肺曲霉菌感染，卡铂芬净联合伏立康唑补救治疗，患者临床治愈。结论糖尿病合并侵袭性肺曲霉菌感染早期诊断非常困难，病死率高，临床医师需提高认识，充分结合患者危险因素、血清学及早期胸部影像学检查诊断侵袭性肺真菌感染，抗真菌药物的联合运用可作为真菌感染的补救治疗方法，降低患者死亡风险。%Objective To review the clinical diagnosis and treatment of invasive pulmonary aspergillus infection complicated with diabetes, and to improve the diagnosis and treatment level of invasive pulmonary aspergillus infection complicated with diabetes.Methods The clinical data of a case of invasive pulmonary aspergillosis complicated with diabetes in the Second Affliated Hospital of Nanchang University and related domestic and foreign literatures were reviewed, and the risk factors, early diagnosis time, serology, chest imaging and drug treatment of invasive pulmonary aspergillosis were analyzed.Results The patients had a history of type 2 diabetes.The chest CT showed nodular shadows, halo sign and multiple cavitates in both lungs, chemical staining of lung tissue was positive, aspergillus silk was found in lung tissue, so the case was clearly diagnosed as invasive pulmonary aspergillosis, after treatment with voriconazole and voriconazole, the case was clinically cured.Conclusion The early diagnosis of invasive pulmonary aspergillus infection complicated with diabetes is very difficult, the disease has high mortality.To raise diagnosis rate, clinicians should raise awareness of risk factors, serology and early chest imaging examination of invasive pulmonary fungal disease.The joint use of antifungal drugs can be used as the remedial treatment of fungal infections, thus the risk of death can be decreased.
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