侵袭性肺曲霉病合并慢性阻塞性肺疾病的临床特征及中医药干预的真实世界研究-东南大学学报医学版

侵袭性肺曲霉病合并慢性阻塞性肺疾病的临床特征及中医药干预的真实世界研究

单位：南京中医药大学附属医院/江苏省中医院急诊科, 江苏南京 210029

分类号：R243;R563;R519.8

出版年·卷·期（页码）：2026·45·第一期（24-33）

摘要：

目的:总结侵袭性肺曲霉病(IPA)合并慢性阻塞性肺疾病(COPD)患者的临床特征,同时探究中药治疗的有效性。方法:采取回顾性研究的方法,收集2021年3月至2025年9月江苏省中医院收治的IPA病例资料,根据是否合并COPD分为曲霉组和曲霉合并COPD组,比较两组临床特征、相关指标的差异。观察中医药干预IPA合并COPD的临床疗效,根据住院期间口服中药时间≥70%分为中药组和对照组,在客观比较两组一般情况后,进行倾向性匹配,比较两组治疗前和治疗14 d后中医症候评分、感染指标、临床疗效及28 d死亡率。结果:共纳入207例IPA患者,其中曲霉组106例,曲霉合并COPD组101例。曲霉合并COPD组患者年龄更大,男性比例高,慢性支气管炎、恶性肿瘤、胆囊结石伴胆囊炎比例更高,糖尿病比例更低,超敏C反应蛋白(CRP)、红细胞(RBC)、纤维蛋白原(FIB)、血红蛋白(Hb)、肌酐(Cr)及二氧化碳分压(PaCO₂)更高,淋巴细胞计数和肌钙蛋白I更低,胸闷气喘、咯血、乏力更加明显,发热比例少(均P＜0.05)。在101例曲霉合并COPD组中,中药组59例,对照组42例,比较一般资料和倾向性匹配后,最终纳入中药组和对照组各35例。中药组痰液分泌和乏力症状改善更明显(P＜0.05),中性粒细胞和淋巴细胞计数提升更明显(P＜0.05);在临床综合疗效、住院时间、费用及28 d死亡率方面,两组比较差异均无统计学意义(P＞0.05)。结论:IPA合并COPD患者在年龄、性别、基础病方面具有特异性,表现更高的CRP、RBC、FIB、Hb、Cr及PaCO₂水平,胸闷气喘、咯血、乏力更加明显。中医药干预可改善痰液分泌和乏力症状,或可提高免疫功能,但在临床综合疗效、住院时间、费用及28 d死亡率方面无明显优势。

Objective: To summarize the clinical characteristics of patients with invasive pulmonary aspergillosis(IPA) complicated by chronic obstructive pulmonary disease(COPD), while investigating the efficacy of traditional Chinese medicine(TCM) treatment. Methods: The study employed a retrospective research method, collecting case data of confirmed IPA cases admitted to Jiangsu Province Hospital of Chinese Medicine between March 2021 and September 2025. Patients were divided into two groups based on whether they had comorbid COPD. Statistical analysis was conducted to compare the clinical characteristics and differences in relevant indicators between the two groups. Secondly, the clinical efficacy of TCM intervention in patients with IPA comorbid with COPD was observed. Patients were divided into a TCM group and a control group based on oral administration duration accounting for ≥70% of the hospitalization period. After objectively comparing the general conditions of the two groups, propensity matching was performed, ultimately including 35 patients in each group. The study compared the TCM symptom scores before and after treatment, as well as infection indicators, between the two groups. Additionally, the final clinical efficacy and 28-day mortality were also compared. Results: A total of 207 cases were included, consisting of 106 in the non-COPD group and 101 in the COPD group. A comparison of clinical characteristics revealed that patients in the COPD group were older, had a higher proportion of males, and a higher incidence of underlying conditions such as chronic bronchitis, malignant tumors, and gallstones with cholecystitis, while the proportion of diabetes was lower. In terms of serological tests, CRP, RBC, FIB, Hb, Cr, and PaCO₂ were higher, while lymphocyte count and troponin I were lower. Symptoms such as chest tightness, shortness of breath, hemoptysis, and fatigue were more pronounced, and the proportion of fever was lower(P<0.05). Among the 101 patients in the COPD group, 59 were in the TCM group and 42 in the control group. After comparing general information and propensity matching, 35 patients were finally included in each group. Comparison showed that the TCM group exhibited more significant improvements in sputum secretion and fatigue symptoms(P<0.05), as well as more notable increases in neutrophil and lymphocyte counts(P<0.05). There were no statistically significant differences between the two groups in terms of overall clinical efficacy, length of hospital stay, cost, and 28-day mortality(P>0.05). Conclusion: Patients with IPA complicated by COPD exhibit specificity in age, gender, and underlying conditions, and have higher levels of CRP, RBC, FIB, Hb, Cr, and PaCO₂, as well as more pronounced symptoms such as chest tightness, shortness of breath, hemoptysis, and fatigue. TCM intervention can improve sputum secretion and fatigue symptoms, and may enhance immune function, but it shows no significant advantages in terms of comprehensive clinical efficacy, length of hospital stay, medical costs, or 28-day mortality.

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