肺结核患者真菌感染的CT影像特点研究  

CT imaging characteristics of pulmonary tuberculosis patients complicated with fungal infection

作　　者：韦琳[1] 卢忠武[1] 罗英杰[1] 李力[1] 陆泳梁 唐运军 

机构地区：[1]河池市人民医院放射科,广西河池547000

出　　处：《中华医院感染学杂志》2017年第17期3921-3924,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨肺结核并发真菌感染患者的CT影像学诊断特点及临床价值。方法分析2011年6月-2016年6月于医院治疗的392例肺结核患者的临床资料,根据ATS真菌感染专家组发布的成人呼吸与重症监护患者真菌感染治疗指南,从392例肺结核患者中选出合并真菌感染的患者。将患者分为观察组(肺结核合并真菌感染)和对照组(肺结核未合并真菌感染);记录患者治疗前后的临床资料,对两组患者进行X线及CT检查,观察两组患者的影像学特征。结果观察组真菌培养率为100.0%,共检测出85株真菌,其中白假丝酵母、隐球菌、曲霉菌、热带假丝酵母以及光滑假丝酵母分别占38.8%、31.8%、9.4%、8.2%及7.0%;肺结核合并真菌感染诊断方法中,CT检查阳性率达72.9%,明显高于X线检查阳性率11.8%,两者差异有统计学意义(P<0.05);结合细菌学培养结果绘制ROC曲线,CT检查的AUC为0.792,X线的曲线下面积为0.673,提示CT检查诊断准确性更高;比较两组患者的CT影像学表现,肺结核合并真菌感染累及两个肺叶比例达82.4%,远高于对照组患者,差异有统计学意义(P<0.05);观察组存在空洞的患者达32.9%,存在胸腔积液及支气管散播的患者达40.0%及60.0%,远高于对照组患者(P<0.05)。结论肺结核合并真菌感染患者的CT影像学检查阳性率高,密度分辨率和空间分辨率都较高,多呈现双肺弥漫性病变,优于常规X线检查,有助于临床上检查肺结核合并感染的诊断。OBJECTIVE To explore the CT imaging features of pulmonary tuberculosis patients complicated with fungal infection and analyze the clinical diagnostic value.METHODS The clinical data were collected from 392 patients with pulmonary tuberculosis who were treated in the hospital from Jun 2011 to Jun 2016 and were analyzed,the patients complicated with fungal infection were screened out from the 392 patients with pulmonary tuberculosis according to the guidelines for treatment of adult respiratory and intensive care patients with fungal infection issued by ATS fungal infection expert group.The pulmonary tuberculosis patients complicated with fungal infection were assigned as the observation group,and the pulmonary tuberculosis patients without fungal infection were set as the control group.The clinical data of the patients were recorded before and after the treatment,the X-ray and CT examinations were carried out for the tow groups of patients,and the imaging features of the two groups of patients were observed.RESULTS The rate of fungal culture of the observation group was 100.0%.A total of 85 strains of fungi were isolated,of which 38.8%were Candida albicans,31.8%were Cryptococcus,9.4%were Aspergillus,8.2%were Candida tropicalis,and 7.0%were Candida glabrata.The positive rate of CT examination was 72.9%in diagnosis of the pulmonary tuberculosis complicated with fungal infection,significantly higher than 11.8%of the X-ray examination（P〈0.05）.ROC curve was drawn on the basis of the result of bacteriologic culture,the AUC of the CT examination was 0.792,the X-ray examination 0.673,indicating that the accuracy of the CT examination was higher.The CT imaging findings showed that the proportion of the patients with two lung lobes involved was 82.4%in the observation group,significantly higher than that in the control group（P〈0.05）;the proportion of the patients with hollow was 32.9%in the observation group,significantly higher than that in the control group,the proportions of the patients with pleural effusion

关 键 词：肺结核 真菌感染 CT 影像 

分 类 号：R521[医药卫生—内科学]