肺部侵袭性曲霉菌和白色念珠菌感染的临床与CT表现比较  

Comparison of Clinical and CT Findings of Invasive Aspergillusand Candida Albicans Infections in the Lung

作　　者：李晗婷 韩小雨 郑雨婷 史河水[1] LI Hanting;HAN Xiaoyu;ZHENG Yuting(Department of Radiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei Province 430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,分子影像湖北省重点实验室,武汉430022

出　　处：《临床放射学杂志》2024年第4期543-548,共6页Journal of Clinical Radiology

摘　　要：目的 比较肺部侵袭性曲霉菌与白色念珠菌感染的CT表现,以期有助于二者的临床诊断与鉴别。方法回顾性分析209例肺部侵袭性真菌感染患者的临床和影像资料,依据真菌类型分为曲霉菌组和白色念珠菌组,观察记录其CT表现。依据影像学表现,将CT表现分为A型(实变为主型)、B型(磨玻璃影为主型)、C型(结节或肿块为主型)、D型(空洞为主型)。运用人工智能定量分析比较患者肺部病变累及程度和范围。依据病灶占比,将肺部受累程度分为轻度(<20%)、中度(20%~40%)和重度(>40%)。结果 肺部曲霉菌感染与白色念珠菌感染多发于中老年男性和免疫功能低下者。两者主要CT表现以累及双肺的实变为主型病变最为常见,其他CT征象以胸膜增厚(58.6%vs 59.0%)最为多见,胸腔积液(31.0%vs 57.4%)次之。曲霉菌组胸腔积液发生率低于白色念珠菌组(P<0.001)。曲霉菌组右肺中叶[27.7(3.1,90.5)cm^(3) vs 9.2(0.9,26.1)cm^(3),P=0.005]、左肺上叶[74.0(2.1,250.9)cm^(3) vs 16.7(2.9,57.3) cm^(3),P=0.006]和左肺下叶[100.1(21.5,245.9)cm^(3) vs 56.8(10.2,110.1)cm^(3),P=0.010]处的病灶体积显著大于白色念珠菌组。在肺部受累程度上,两者均以轻度为主(73.1%vs 88.0%),但曲霉菌组中度(19.4%vs 9.4%)和重度(7.5%vs 2.6%)发生率显著高于白色念珠菌组(P=0.038)。结论 肺部侵袭性曲霉菌与白色念珠菌感染的CT表现具有差异,CT扫描有助于明确诊断和进行临床诊治。Objective To observe and compare the CT findings of pulmonary invasive aspergillus and Candida albicans infection in order to contribute to the clinical diagnosis and differentiation of pulmonary fungal infection.Methods The clinical and imaging data of 209 patients with pulmonary fungal infection were analyzed retrospectively.According to the type of fungi,they were divided into Aspergillus group and Candida albicans group,and their CT signs were observed and re⁃corded.According to the imaging findings,CT images were divided into type A(mainly consolidation type),type B(mainly ground glass density shadow type),type C(mainly nodules or masses type)and type D(mainly cavity type).Artificial in⁃telligence(AI)was used to quantitatively analyze and compare the extent and scope of pulmonary lesions.According to the proportion of lesions,the degree of bilateral lung involvement is divided into mild(<20%),moderate(20%-40%)and severe(>40%).Results Pulmonary Aspergillus infection and Candida albicans infection were more common in mid⁃dle⁃aged and elderly men and immunocompromised patients,and the main CT findings of both were consolidation lesions in⁃volving both lungs.Other CT findings in both groups were most common with pleural thickening(58.6%vs 59.0%),fol⁃lowed by pleural effusion(31.0%vs 57.4%).The incidence of Pleural effusion in Aspergillus group was significantly low⁃er than that in Candida albicans group(P<0.001).The lesion volumes at the middle lobe of the right lung[27.7(3.1,90.5)cm^(3) vs 9.2(0.9,26.1)cm^(3),P=0.005],upper lobe of the left lung[74.0(2.1,250.9)cm^(3) vs 16.7(2.9,57.3)cm^(3),P=0.006]and lower lobe of the left lung[100.1(21.5,245.9)cm^(3) vs 56.8(10.2,110.1)cm^(3),P=0.010]were significantly larger in the Aspergillus group than in the Candida albicans group.In terms of the degree of bilateral lung in⁃volvement,both were mainly mild(73.1%vs 88.0%),but the incidence of moderate(19.4%vs 9.4%)and severe(7.5%vs 2.6%)in Aspergillus group was significantly higher than that in Candida albi

关 键 词：曲霉菌 白色念珠菌 真菌感染 体层摄影术 X线计算机 

分 类 号：R519[医药卫生—内科学] R816.4[医药卫生—临床医学]