关键词: 慢性肾脏病, 侵袭性肺曲霉病, 免疫抑制剂

Abstract: Ｏｂｊｅｃｔｉｖｅ：To evaluate the clinical characteristics and prognosis of chronic kidney disease (CKD) patients with invasive pulmonary aspergillosis （IPA） retrospectively.
Ｍｅｔｈｏｄｏｌｏｇｙ：We retrospectively analyzed the clinical and imaging features of CKD patients with IPA who were admitted to the National Clinical Research Center of Kidney Diseases, Jinling Hospital from January 2009 to January 2020.
Ｒｅｓｕｌｔｓ：Among the 46 CKD patients with IPA, 4 patients met the proven and 42 patients met the probable diagnostic criteria.The top three original kidney diseases were lupus nephritis (1739%), diabetic nephropathy (1522%) and renal transplantation  (1522%).Fortyone patients had received an average of 2 (1,3) types of immunosuppressive therapy. There were 20 patients had diabetes mellitus, 8 patients had chronic obstructive pulmonary disease (COPD), and only 1 patient complicated with neutropenia. The most common chest CT signs are nodules and consolidations, and the typical CT signs such as halo sign appeared later. Twentyone patients (4565％) died within 30 days of followup, and 25 patients (5435％) died after 1 year of followup.Multivariate COX regression found that the median dose of prednisone within 1 month before IPA and the need for vasoactive drugs were independent risk factors for death.
Ｃｏｎｃｌｕｓｉｏｎ：Risk factors for IPA in CKD patients include kidney transplantation, immunosuppressant use, diabetes, and COPD. The clinical and imaging features of IPA in CKD patients were atypical. Chest CT mainly showed airway invasive signs, and the typical halo sign appeared later. CKD patients receiving high dose prednisone before IPA have a worse prognosis, need prompt diagnosis and preemptive treatment.

Key words: chronic kidney disease, invasive pulmonary aspergillosis, immunosuppressant