肺曲霉菌感染患者的临床及影像学特征分析  

Clinical and imaging characteristics of patients with pulmonary Aspergillus infection

作　　者：王续[1] 王伟 赵莹 WANG Xu;WANG Wei;ZHAO Ying(Department of Medical Imaging,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473006,China)

机构地区：[1]南阳医学高等专科学校第一附属医院医学影像科,河南南阳473006

出　　处：《中国病原生物学杂志》2024年第10期1158-1161,1166,共5页Journal of Pathogen Biology

摘　　要：目的 分析肺曲霉菌感染患者的临床特征、影像学表现及治疗预后情况,以期提高疾病早期诊断率并指导临床治疗决策。方法 选取2019年3月至2024年3月期间在本院确诊为肺曲霉菌感染的120例患者,经纳入及排除标准,98例入选研究对象。收集其临床资料,包括一般资料、临床特征、影像学特征和实验室检查指标等。通过统计分析方法比较不同类型肺曲霉菌感染患者的临床和影像学特征。结果 98例患者中,男55例,女43例,年龄范围18-82岁。单纯性肺曲菌球病(SPA)45例,侵袭性肺曲霉病(IPA)53例。临床特征:IPA患者发热比例高于SPA患者(45.28%vs 11.11%,P<0.05)。两组患者均存在咳嗽和咳痰症状,但IPA患者比例更高(咳嗽:94.34%vs 71.11%,P=0.002;咳痰:75.47%vs 33.33%,P<0.05)。SPA患者咯血比例显著高于IPA患者(60.00%vs 32.08%,P=0.006)。影像学特征:SPA患者病灶多位于单叶(73.33%),而IPA患者则更倾向于双叶受累(58.49%)(P=0.025)。SPA患者单个病灶更常见(51.11%),IPA患者则更倾向于多个病灶(77.36%)(P=0.032)。SPA患者更易出现空洞征(57.78%),IPA患者则更易出现斑影征(73.58%)(P=0.031)。SPA患者的空洞以薄壁为主(35.56%),IPA患者的空洞则以厚壁为主(21.15%)(P=0.022)。实验室检查指标:IPA患者的红细胞计数和血红蛋白水平显著高于单纯性肺曲菌球病患者(P<0.05)。治疗及预后:SPA患者多采用抗真菌治疗,辅以手术治疗和综合治疗策略,预后较好。IPA患者更多采用抗真菌药物的联合治疗,并考虑免疫调节治疗,预后因病情严重程度和免疫状态而异。结论 不同肺曲霉菌感染患者在临床表现、影像特征及实验室指标上有区别,应据此定制治疗计划并动态评估病情。Objective To analyze the clinical features,imaging manifestations,and treatment outcomes of patients with pulmonary aspergillosis,aiming to improve early diagnosis rates and guide clinical treatment decisions.Methods A total of 120 patients diagnosed with pulmonary aspergillosis in our hospital from March 2019 to March 2024 were selected.After applying inclusion and exclusion criteria,98 patients were included in the study.Clinical data,including general information,clinical features,imaging features,and laboratory test indicators,were collected.Statistical analysis was used to compare the clinical and imaging features of patients with different types of pulmonary aspergillosis.Results Among the 98 patients,55 were male and 43 were female,with ages ranging from 18 to 82 years.There were 45 cases of simple pulmonary aspergilloma(SPA)and 53 cases of invasive pulmonary aspergllosis(IPA).Clinical features:The proportion of fever was higher in IPA patients than in SPA patients(45.28%vs 11.11%,P<0.05).Both groups exhibited cough and sputum production,but the proportion was higher in IPA patients(cough:94.34%vs 71.11%,P=0.002;sputum production:75.47%vs 33.33%,P<0.05).Hemoptysis was significantly more frequent in SPA patients than in IPA patients(60.00%vs 32.08%,P=0.006).Imaging features:SPA lesions were more often located in a single lobe(73.33%),while IPA lesions were more likely to involve both lobes(58.49%)(P=0.025).SPA patients had a higher frequency of single lesions(51.11%),while IPA patients were more likely to have multiple lesions(77.36%)(P=0.032).SPA patients were more prone to cavitary signs(57.78%),while IPA patients exhibited more patchy shadows(73.58%)(P=0.031).Cavities in SPA patients were primarily thin-walled(35.56%),while those in IPA patients were predominantly thick-walled(21.15%)(P=0.022).Laboratory test indicators:IPA patients had significantly higher red blood cell counts and hemoglobin levels than SPA patients(P<0.O5).Treatment and prognosis:SPA patients were mainly treated with antifungal therap

关 键 词：肺曲霉菌感染 临床特征 影像学特征 诊断 治疗 

分 类 号：R519[医药卫生—内科学]