肺结核合并真菌感染患者的CT影像特点研究  

CT features of pulmonary tuberculosis with fungal infection

作　　者：张含芝 孙琪[1] 袁婧[3] 邱小伟[3] 崔岩飞[4] 余日胜[1] ZHANG Han-zhi;SUN Qi;YUAN Jing;QIU Xiao-wei;CUI Yan-fei;YU Ri-sheng(The Second Affiliated Hospital of Zhejiang University Medical College,Hangzhou,Zhejiang 310009,China)

机构地区：[1]浙江大学医学院附属第二医院放射科,浙江杭州310009 [2]浙江省中西医结合医院特检科,浙江杭州330100 [3]浙江省中西医结合医院放射科,浙江杭州330100 [4]浙江省中西医结合医院结核科,浙江杭州330100

出　　处：《中华医院感染学杂志》2018年第15期2257-2260,共4页Chinese Journal of Nosocomiology

基　　金：浙江中医药科技基金资助项目(2016ZB098)

摘　　要：目的探讨肺结核合并真菌感染患者的CT影像特点。方法选取2014年3月-2017年3月医院收治的118例肺结核合并真菌感染患者为试验组,另外选取同期于医院治疗的肺结核未合并真菌感染的患者100例为对照组。采集患者痰液,检测致病菌类型;所有患者行CT检查。统计两组患者一般资料,分析肺结核合并真菌感染患者的病原菌特点,观察分析患者的CT表现特点。结果 118例肺结核合并真菌感染的患者中共分离出136株真菌菌株,其中以曲霉菌属102株占75.00%为主;118例患者CT显示病灶位于双肺35.59%,累及2个肺叶46.61%;CT表现为空洞影79.66%、结节影74.58%,以空洞影、结节影、斑片状影和树芽征为多见;试验组CT显示两个肺叶受累、支气管播散、胸腔积液和空洞的概率均高于对照组(P<0.05)。结论曲霉菌属是导致肺结核患者发生肺部真菌感染的主要致病菌。肺结核继发肺真菌感染后CT表现多样,感染灶范围扩大,病灶形态边缘更模糊、多样化,胸腔积液率高,支气管播散病灶多。OBJECTIVE To investigate the features of CT imaging in patients with pulmonary tuberculosis and fungal infection.METHODS A total of 118 patients with pulmonary tuberculosis and fungal infection from Mar.2014 to Mar.2017 were selected as the experimental group.In addition,100 patients with pulmonary tuberculosis without fungal infection treated in the hospital during the same period were selected as the control group.The patient＇s sputum was collected and tested for pathogenic bacteria,and all patients underwent CT examination.The general data of the two groups of patients were compared,the pathogenic bacteria and CT manifestations of patients with tuberculosis and fungal infection were analyzed.RESULTS A total of 136 strains of fungal strains were isolated from 118 patients with pulmonary tuberculosis and fungal infection.Of these,102 strains of Aspergillus spp.accounted for 75.00% of the total.In 118 cases,the lesions were found in 35.59% of lungs and 46.61% of lungs in2 lesions.There were 79.66% of voids and 74.58% of nodules.Cavity shadows,nodules,patchy shadows,and tree buds were the most common findings.CT in showed The probability of involvement of the two lobes,bronchial spread,and pleural effusion in the experimental group by CT was significantly higher than that in the control group（P〈0.05）.CONCLUSION Aspergillus is the main pathogenic bacteria causing lung fungal infection in patients with pulmonary tuberculosis.In patients with secondary pulmonary fungal infection after pulmonary tuberculosis,the CT manifestations are various,the scope of the focus of the lesion is extense,the edge of the lesion morphology is more blurred and diversified,the pleural effusion rate is high,and the bronchial disseminated lesions are multiple.

关 键 词：肺结核 真菌 CT 感染 

分 类 号：R521[医药卫生—内科学]