肺曲霉菌病的胸部CT特点  

Chest CT features of pulmonary aspergillosis

作　　者：赵停婷 苏雪媛 李刚 姚瑶 朱力[4] 陈娟[1] 张鹏[1] ZHAO Tingting;SU Xueyuan;LI Gang;YAO Yao;ZHU Li;CHEN Juan;ZHANG Peng(Department of Pulmonary and Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Pulmonary and Critical Care Medicine,Wuzhong People′s Hospital,Wuzhong 751100,China;Medical Center of Laboratory Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院呼吸与危重症医学科,宁夏银川750004 [2]宁夏吴忠市人民医院呼吸与危重症医学科,宁夏吴忠751100 [3]宁夏医科大学总医院医学实验中心,宁夏银川750004 [4]宁夏医科大学总医院放射科,宁夏银川750004

出　　处：《宁夏医学杂志》2022年第10期881-884,共4页Ningxia Medical Journal

基　　金：宁夏自然科学基金重点项目(2020AAC02001);宁夏医科大学校级科研项目(XY2017132);宁夏青年科技人才托举工程项目(TJGC20190096)。

摘　　要：目的 探讨肺曲霉菌病患者胸部CT的影像特点,以提高对肺曲霉病的早期诊断。方法 对临床确诊的肺曲霉菌病患者(曲霉组)107例及60例同期住院的社区获得性肺炎患者(对照组)胸部CT资料特点进行回顾性分析。结果 107例肺曲霉菌病患者中,侵袭性肺曲霉菌病96例(89.7%),变应性支气管肺曲霉菌病8例(7.5%),慢性肺曲霉菌病3例(2.8%);口服激素及免疫抑制剂、基础疾病为肿瘤、糖尿病、血液疾病,存在2种及以上脏器功能不全以及外科手术者较对照组明显增高(P<0.05)。与对照组相比,曲霉组肺影像学更多出现磨玻璃样浸润影、树芽征、空洞病变、胸腔积液、晕轮征及肺部肿块影(P<0.05)。影像学患者同时具有磨玻璃浸润影、树芽征、空洞三种病变时,诊断肺曲霉菌病的灵敏度为47.7%。结论 肺曲霉菌病多见于有基础疾病、器官功能不全和或免疫功能受损的患者;影像学具备磨玻璃浸润影、树芽征、空洞三种病变时,临床必须考虑肺曲霉菌病的可能。Objective To explore the imaging characteristics of chest CT in patients with pulmonary aspergillosis, so as to improve the early clinical identification of pulmonary aspergillosis.Methods The chest CT features of 107 patients with pulmonary aspergillus(aspergillus group)and 60 patients with community acquired pneumonia in the same period were analyzed retrospectively.Results Among 107 patients with pulmonary aspergillosis, 96 cases(89.7%)were invasive pulmonary aspergillosis, 8 cases(7.5%)were allergic bronchopulmonary aspergillosis, and 3 cases(2.8%)were chronic pulmonary aspergillosis.The patients taking oral hormones and immunosuppressive agents, suffering from tumors, diabetes or blood diseases, getting two or more kinds of organ dysfunction or undergoing surgery were significantly higher than those in the bacterial pneumonia group(P<0.05).Compared with the common pneumonia group, the pulmonary imaging of aspergillus group showed more ground-glass opacities, tree-in-bud pattern, cavity lesion, pleural effusion, halo sign and lung mass shadow(P<0.05).The sensitivity of diagnosis of pulmonary aspergillosis was up to 47.7% when imaging patients had three lesions including group-glass opacities, tree-in-bud pattern and cavities.Conclusion Pulmonary aspergillosis is more common in patients with underlying diseases, organ dysfunction, or impaired immune function.The possibility of pulmonary aspergillosis should be considered clinically when there are three kinds of lesions in imaging, named ground-glass opacities, tree-in-bud pattern and cavity lesion.

关 键 词：肺曲霉菌病 影像学 免疫功能受损 

分 类 号：R445[医药卫生—影像医学与核医学]