老年肺曲霉菌病与细菌性肺炎的CT鉴别诊断  

CT findings of elderly patients with pulmonary aspergillosis and bacterial pneumonia

作　　者：刘洪杰[1] 王建军 郑洁 李永元 LIU Hong-jie;WANG Jian-jun;ZHENG Jie;LI Yong-yuan(Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院放射科,天津300450 [2]天津市第五中心医院病理科,天津300450 [3]天津市第五中心医院普外科,天津300450

出　　处：《中华医院感染学杂志》2021年第13期1992-1996,共5页Chinese Journal of Nosocomiology

基　　金：天津市滨海新区卫生计生委科技基金资助项目(2018BWKZ004)。

摘　　要：目的探讨老年肺曲霉菌病的CT表现及与细菌性肺炎的鉴别分析。方法收集2017年1月-2020年12月天津市第五中心医院住院的老年肺曲霉菌病患者29例为肺曲霉菌病组,以及同期住院的老年单纯细菌性肺炎患者42例为细菌性肺炎组;比较两组临床症状、CT征象;以最终确诊结果为"金标准",使用Kappa一致性检验评价CT鉴别诊断肺曲霉菌感染的效能。结果两组患者临床症状主要表现为咳嗽咳痰、发热、胸闷或胸痛、咯血、气促和呼吸困难,其中肺曲霉菌病组患者发热症状发生例数少于细菌性肺炎组患者(P<0.05),其余症状发生例数两组间比较,均无统计学差异。CT征象中,肺曲霉菌病组出现大结节、肿块、树芽征、晕轮征、空气新月征、空洞的比例高于细菌性肺炎组(P<0.05),出现实变、空气支气管征的比例低于细菌性肺炎组(P<0.05);CT鉴别诊断肺曲霉菌病与确诊结果一致性较好(Kappa值=0.543),其灵敏度、特异度和准确度分别为79.31%、76.19%和77.46%;胸部CT检查、痰真菌培养及血液培养诊断肺曲霉菌病受试者工作特征(ROC)曲线下面积(AUC)比较,无统计学差异。结论老年肺曲霉菌病CT影像表现多样,树芽征、晕轮征、空气新月征、空洞等CT征象有助于肺曲霉菌病的诊断及鉴别诊断。OBJECTIVE To explore the CT findings of the elderly patients with pulmonary aspergillosis and distinguish it from bacterial pneumonia.METHODS A total of 29 elderly patients with pulmonary aspergillosis who were hospitalized in the Tianjin Fifth Central Hospital from Jan 2017 to Dec 2020 were assigned as the pulmonary aspergillosis,meanwhile,42 elderly patients with simple bacterial pneumonia were assigned as the bacterial pneumoniae group.The clinical symptoms and CT signs were compared between the two groups.Taking the final confirmed results as the golden standard,Kappa consistency test was used to evaluate the efficacy of CT in differential diagnosis of pulmonary Aspergillus infection.RESULTS Cough and expectoration,fever,chest tightness or chest pain,hemoptysis,polypnea and dyspnea were the major clinical symptoms of the two groups of patients;the number of cases of fever was significantly less in the pulmonary aspergillosis group than in the bacterial pneumonia group(P<0.05);there was no significant difference in the number of cases of other symptoms between the two groups.Among the CT signs,the proportions of the patients who had large nodules,lumps,tree-in-bud pattern,halo signs,air meniscus sign and cavities were significantly higher in the pulmonary aspergillosis group than in the bacterial pneumonia group(P<0.05);the proportions of the patients who had consolidation and air bronchial signs were significantly lower in the pulmonary aspergillosis group than in the bacterial pneumonia group(P<0.05).The differential diagnosis with CT was highly consistent with the confirmed results(Kappa value=0.543),and the sensitivity,specificity and accuracy were respectively 79.31%,76.19%and 77.46%.There was no significant difference in the area under curve(AUC)of receiver operation characteristic among the chest CT examination,sputum culture and blood culture.CONCLUSION The elderly patients with pulmonary aspergillosis show diversified CT findings;tree-in-bud pattern,halo signs,air meniscus sign and cavities may facili

关 键 词：老年 肺曲霉菌病 细菌性肺炎 计算机断层扫描 诊断 

分 类 号：R445.3[医药卫生—影像医学与核医学]