慢性乙型病毒性肝炎合并侵袭性肺真菌感染的临床及影像学特点  

Clinical and imaging features of invasive pulmonary fungal infections in patients with chronic hepatitis B

作　　者：唐吉仙 张春意[1] 沈巨信[1] 蒲桂梅 TANG Jixian;ZHANG Chunyi;SHEN Juxin(Department of Respiratory Medicine,Shaoxing People’s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院呼吸内科

出　　处：《浙江医学》2019年第17期1853-1855,1860,共4页Zhejiang Medical Journal

摘　　要：目的探讨慢性乙型病毒性肝炎(简称慢性乙肝)合并侵袭性肺真菌感染(IPFI)患者的临床及影像学特点。方法选取2013年6月至2018年6月收治的40例慢性乙肝合并IPFI患者为研究对象,回顾性分析其临床症状、病原菌分布、胸部影像学特点及诊治情况。结果40例慢性乙肝合并IPFI患者中,肺隐球菌19例(47.5%),肺曲霉菌18例(45.0%),肺孢子菌3例(7.5%)。支气管镜检出7例(17.5%),经皮肺穿刺活检检出20例(50.0%)。10例(25%)为老年患者(>65岁),17例(42.5%)合并有肝硬化。CT征象中出现最多的为结节(30例,75.0%);以胸膜下、沿支气管走向分布多见。肺曲霉菌感染患者老年、高谷丙转氨酶水平(>400U/L)、低白蛋白水平(<30g/L)、慢加急性肝衰竭、合并肝硬化或肺结构病比例均高于肺隐球菌感染患者(均P<0.05)。死亡3例(7.5%),均为肺曲霉菌感染,均合并慢加急性肝衰竭。结论慢性乙肝合并IPFI患者中,以肺隐球菌、肺曲霉菌感染最为常见,肺部CT表现多为结节。综合评估基础疾病和影像学特点,借助支气管镜、经皮肺穿刺活检等手段,有助于对患者早期诊断和及时治疗。Objective To analyze the clinical and imaging characteristics of invasive pulmonary fungal infection(IPFI) in patients with chronic hepatitis B. Methods The clinical symptoms, pathogenic bacteria distribution, chest imaging characteristics and related factors of 40 cases diagnosed as hepatitis B complicated with IPFI in Shaoxing People’s Hospital from June 2013 to June 2018 were retrospectively analyzed. Results Among 40 cases of chronic hepatitis B complicated with IPFI, there were 19 cases of pulmonary cryptococcal infection(47.5%), 18 cases of pulmonary aspergillosis(45%), and 3 cases of pulmonary sporozoosis(7.5%). The diagnosis was confirmed by bronchoscopy in 7 cases(17.5%) and by transthoracic needle biopsy in 20 cases(50%). Among 40 patients, 10 were aged >65 years(25%), and 17 had cirrhosis(42.5%). The proportion of older age, high glutamic-pyruvic transaminase(GPT), chronic and acute liver failure, cirrhosis, pulmonary structural disease and low albumin level in patients with pulmonary aspergillosis were higher than that in patients with pulmonary cryptococcal infection. The most common CT signs were nodules, followed by ground glass opacity, consolidation and cavity;and most of the lesions had subpleural and tracheobronchial distribution. Three of the 40 patients died, all of whom were pulmonary aspergillosis and complicated with chronic and acute liver failure. Conclusion Among the patients with chronic hepatitis B complicated with IPFI, pulmonary aspergillosis and pulmonary cryptococcal infection are more common. Nodules are the most common pulmonary CT findings.

关 键 词：慢性乙型病毒性肝炎 侵袭性肺真菌感染 胸部影像学 

分 类 号：R512.62[医药卫生—内科学]