免疫缺陷患者感染巨细胞病毒性肺炎影像学特征变化与其严重程度的关系研究  

Study on the relationship between the changes in lung imaging characteristics and its severity in immunocompromised patients with CMV pneumonia

作　　者：张文涛 马晓璇 李存瑞 徐志富 薛秀斌 ZHANG Wentao;MA Xiaoxuan;LI Cunrui;XU Zhifu;XUE Xiubin(CT Room of Zhangjiakou First Hospital, Zhangjiakou 075000, P.R.China)

机构地区：[1]河北省张家口市第一医院CT室,河北张家口075000

出　　处：《医学影像学杂志》2018年第12期2026-2029,2034,共5页Journal of Medical Imaging

基　　金：卫生部医药卫生科技项目(编号:13010520161796);河北省医学科学研究重点课题计划项目(编号:20171268)

摘　　要：目的探讨免疫缺陷患者感染巨细胞病毒性肺炎的肺部影像学特征变化与其严重程度的关系。方法分析我院收治的54例肺部感染免疫缺陷患者。根据患者感染的类型分为单纯组和混合组。单纯组(n=28)为CMV肺炎患者,混合组(n=26)为CMV和克雷伯杆菌感染肺炎。观察两组CT特征(数量、结构、质地、厚度、脓腔积气、分隔强化、迁移性感染)、病态形变(叶的实变、段的实变、毛玻璃样影和网织条索、小叶分布型的毛玻璃样影、多发性的小结节病灶以及充气支气管征)、分布特点(单侧单叶、单侧多叶、双侧肺,肺间质、肺实质)。结果混合组和单纯组的CT特征进行分析发现,混合组在病灶数量> 1、结构的呈现多房、病灶厚度上> 2mm、迁移性感染均显著高于单纯组。对两组患者的病变形态进行研究发现,混合组在叶的实变、小叶分布型的毛玻璃样影、以及充气支气管征要显著高于单纯组。对两组患者分布特点进行分析发现,混合组肺间质患者为92. 31%,要远高于对照组肺间质的71. 43%,两组患者在肺间质和肺实质上差异显著。结论在免疫缺陷患者常会出现多种肺部感染,在对于患者进行诊断时应该采用影像学结合病理组织病理学检测,由于本文选取的样本容量不足,因此对于CMV肺炎患者的具体临床特征存在一定的差异,需要进一步的研究。Objective To inquire into the relationship between the changes in lung imaging characteristics and its severity in immunocompromised patients with pneumonia infected by cytomegalovirus( CMV). Methods In this work,we retrospectively analysed 54 cases of pulmonary infection in patients with immune deficiency in our hospital from April 2015 to August 2017. According to the type of infection,those patients were divided into pure and mixed group. In the simple group( n = 28) 28 patients were infected by CMV. In the mixture group,26 patients were were infected by CMV and Klebsiella Pneumoniae. We Observed CT features of patients in the two groups in terms of quantity,structure and texture,thickness,pus,separation enhancement,mobility infection,,pathological deformation( leaf consolidation),a glass shadow and a net,leaf-type shadow on leaflets,multiple nodules,air bronchogram as well as distribution( single leaf,multiple leaves,bilateral lungs,lung stroma,and substance of the lung). Results Analysis of CT characteristics of patients in mixed and pure group found that,in the mixed group,the quantity of lesion was > 1. The structure presented more room. The focal thickness was > 2 mm. Mobility infection were significantly higher than that of pure group( X^2= 5. 004,4. 987,14. 552,4. 987,P < 0. 05). The study on the lesions in both groups showed that the mixture was in the leaf. The inflation bronchi was significantly higher than the simple group( X^2= 13. 217,7. 651,13. 217,P < 0. 05). We analyzed that distribution characteristics of patients in two groups and found that. the hybrid lung was 92. 31%,which was much higher than 71. 43% of the control lung. Patients in two groups showed significant difference in pulmonary interstitial tissue and parenchyma( X^2= 3. 895,P < 0. 05). Conclusion Multiple lung infections occur in immunodeficiency patients. It should be used in the diagnosis of a patient. Due to the limitation of sample size,there is a certain difference in specific clinical features for patients with CMV pneumoni

关 键 词：CMV肺炎 免疫缺陷 肺部感染 体层摄影术 X线计算机 

分 类 号：R512.91[医药卫生—内科学] R814.42[医药卫生—临床医学]