摘要
目的探讨侵袭性肺曲霉菌感染多层螺旋CT(MSCT)图像特点及预后情况,为临床医师诊治提供参考。方法选取2014年5月-2016年5月82例侵袭性肺曲霉菌感染者纳入本研究,所有患者均采用MSCT检查、诊断,所有患者均采用伏立康唑针剂静脉滴注,首日6mg/kg,每12小时1次;之后4mg/kg,每12小时1次;序贯伏立康唑片口服,4mg/kg,每12小时1次治疗;疗程根据患者临床表现及实验室指标等决定;根据患者预后将其分为无效组(20例)与有效组(62例);分别于治疗前、治疗3、6周时采用MSCT检查其胸部影像变化,计算MSCT诊断侵袭性肺曲霉菌的诊断准确度、特异度、灵敏度、阳性预测值及阴性预测值。结果 MSCT诊断侵袭性肺曲霉菌的诊断准确度、特异度、灵敏度、阳性预测值及阴性预测值分别为80.49%、81.25%、80.00%、86.96%、72.22%;血液患者MSCT影像中,实变、团块影比率明显高于非血液病患者(P<0.05);患者感染病灶主要以双肺多发为主,且以上叶多见,外周带比率较高;CT征象:结节灶、实变影、团块影、斑片影、空洞、晕轮征等;经治疗3周后,有效组渗出病变率明显低于无效组(P<0.05);经治疗6周后,有效组渗出和结节及空洞病灶率明显低于无效组(P<0.05)。结论采用MSCT诊断侵袭性肺曲霉菌感染可为患者临床预后、病情评估提供一定参考。
OBJECTIVE To explore the features of multislice spiral CT （MSCT） image of invasive pulmonary aspergillosis and observe the prognosis so as to provide guidance for clinical diagnosis and treatment. METHODS A total of 82 patients with invasive pulmonary aspergillosis who were treated in hospitals from May 2014 to May 2016 were enrolled in the study. All of the enrolled patients received MSCT examination for diagnosis and were treated with intravenous drip of voriconazole injection, 6 mg/kg for the first day, once every 12 hours, then 4 mg/kg, once every 12 hours; sequential oral administration of voriconazole tablets, 4 mg/kg, once every 12 hours. The treatment courses were determined based on clinical manifestations and laboratory indexes. The patients were divided into the ineffective group with 20 cases and the effective group with 62 cases according to the prognosis. The chest images of the patients were observed by using MSCT before treatment and after the treatment for 3 and 6 weeks. The accuracy, specificity, sensitivity, positive predicative value, and negative predictive value of the MSCT in diagnosis of invasive pulmonary aspergillosis were calculated. RESULTS The accuracy, specificity, sensitivity, positive predicative value, and negative predictive value of the MSCT in diagnosis of invasive pulmonary aspergillosis were 80.49%, 81.25%, 80.00%, 86.96%, and 72.22%, respectively. The MSCT imaging showed that the ratios of consolidation and block mass were significantly higher in the hematological disease patients than in the non-hematological disease patients （P〈0.05）. Bilateral pulmonary multiple infection lesions were dominant, the upper lung lobes lesions were the most common, and peripheral band rate was relatively high. The CT signs were as follows： nodules, solid shadow, mass shadow, patchy shadow, hollow, and halo sign. The rate of exudative lesions of the effective group was significantly lower than that of the ineffective group after the treatment for 3 weeks （P〈0.05）; the rates of effusions, nodules, and hollow lesions were significantly lower in the effective group than in the ineffective group （P〈0.05）. CONCLUSION The use of MSCT in diagnosis of invasive pulmonary aspergillosis may provide certain guidance for assessment of clinical prognosis and illness condition of the patients.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第2期296-299,共4页
Chinese Journal of Nosocomiology
基金
浙江省医学会临床科研资金项目(2011zyc-B04)
