摘要
目的探讨侵袭性肺曲霉菌感染胸部多层螺旋CT(MSCT)的征象及显示情况。方法选择2010年2月至2015年10月武汉市汉南区人民医院诊治的120例拟诊为侵袭性肺曲霉菌感染者为研究对象。观察侵袭性肺曲霉菌感染肺部病灶的分布特征、形态特征及MSCT征象。结果以病理或痰培养结果为金标准,MSCT共正确诊断侵袭性肺曲霉菌感染85例,正确排除侵袭性肺曲霉菌感染25例,灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为94.4%(85/90)、83.3%(25/30)、94.4%(85/90)、83.3%(25/30)、91.7%(110/120)。侵袭性肺曲霉菌感染病灶分布右肺多于左肺,且以双肺多发为主(38例,占42.2%)。上叶病灶数量(50例,占55.6%)多于中下叶(40例,占44.4%),外周带比例(62例,占68.9%)高于内中带(28例,占31.1%)。侵袭性肺曲霉菌感染肺部CT征象包括实变、结节、空洞、磨玻璃等,其中斑片状影双侧多发,上肺多见;团块影双侧病变多见,上肺为主,单发与多发相当;结节灶以单侧多发,各肺叶分布相当;空洞以上肺多发为主;星月征及枝桠征均以单侧上肺单发多见;晕轮征以上肺多发为主。血液病与非血液病患者侵袭性肺曲霉菌感染MSCT征象中,血液病患者斑片影、实变及团块影的比例均显著高于非血液病患者[76.0%(38/50)比51.4%(18/35),26.0%(13/50)比8.6%(3/35),66.0%(33/50)比20.0%(7/35)],差异有统计学意义(P<0.05)。结论侵袭性肺曲霉菌感染的诊断中,MSCT可以显示肺内病变的部位、数量、形态学特征,且均具有一定的规律性,有助于定性诊断。
Objective To investigate the MSCT characteristics and display of invasive pulmonary Aspergillus infection. Methods Total of 120 patients with invasive pulmonary Aspergillus infection in Hannan District People＇s Hospital from Feb. 2010 to Oct. 2015 were included in the study. The distribution, morphology and MSCT signs of pulmonary lesions in the lung were observed. Results With pathology or sputum culture result as the golden standard, MSCT correctly diagnosed 85 cases of invasive pulmonary Aspergillus infection, and correctly excluded invasive pulmonary Aspergillus infection in 25 cases. The sensitivity, specificity, positive predictive rate, negative predictive rate, correct rate were 94. 4% （ 85/90 ）, 83.3 % （25/30）, 94. 4% （85/90） ,83.3% （25/30） ,91.7% （ 110/120）, respectively. Invasive pulmonary Aspergillus infection was more often observed in the right lung than the left lung, and double lung multiple lesions dominated （ 38 cases ,42. 2% ）. The lesions of upper lobe （50 cases,55.6% ） was more than the middle and lower lobe （40 cases,44. 4% ）, and the proportion of peripheral zone （40 cases,44. 4% ） was higher than the inner part （28 cases, 31.1% ）. The CT signs included mass lesion, nodules, cavities, grinding glass, etc. , among which the patchy shadows were more common in the upper lung on both sides ; the mass lesion was more com- mon in both sides mostly in the upper lung, and the single and multiple lesions were equivalent; nodules were mostly unilateral multiple lesions, distributed similarly in different lobes;cavities were mostly in the upper lung;the moon/star sign and branches sign were mostly in unilateral upper lung; halo signs were mostly multiple lesions in upper lung. As for the MSCT features of invasive pulmonary Aspergillus infection in patients with hematologic diseases and non-hematologic diseases, the proportion of patches, mass lesions and patchy shadows of the hematologic patients were significantly higher than the non-hematologic disease patients [76. 0% （38/50） vs 51.4% （18/35） ,26. 0% （ 13/50 ） vs 8.6% （3/35） ,66. 0% （33/50） vs 20. 0% （7/ 35 ） ], the differences were statistically significant （ P 〈 0. 05 ）. Conclusion MSCT can display the location, number and morphology of lesions in the lung with a certain regularity in the diagnosis of invasive pulmonary Aspergillus infection,which is helpful to the qualitative diagnosis.
出处
《医学综述》
2016年第13期2666-2669,共4页
Medical Recapitulate
关键词
真菌感染
曲霉菌感染
肺部
螺旋CT
Fungal infection
Aspergillus infection
Pulmonary
Spiral CT
