侵袭性肺曲霉菌感染CT特征与预后

CT Features and Prognostic Value in Invasive Pulmonary Aspergillosis

目的探讨侵袭性肺曲霉病(IPA)影像学特征及肺部病灶演变与预后的关系。方法搜集2010年1月至2012年3月痰培养曲霉菌阳性住院患者167例,对其中临床诊断为IPA的60例患者的胸部CT影像资料进行回顾性分析。采用PEMS 3.1医学统计软件分析数据,计数资料用χ2检验。结果肺部多发性结节为最常见病灶(81.7%,49/60),其次是空洞(61.7%,37/60),肺实变最少(11.7%,7/60),"晕轮征"发生率不低(68.3%,41/60)。"晕轮征"发生比较早(第1～2周),"新月征"发生晚(第2～3周)。血液病和非血液病肺部CT影像特征基本一致,差异无统计学意义。治疗有效肺部病灶在第3周趋于稳定,第4周病灶基本得到控制。恶化组与好转组比较,实变(第4～6周)(χ2=4.82,P=0.028;χ2=9.0,P=0.003;χ2=11.0,P=0.001)空洞(第4周)(χ2=4.81,P=0.028)病灶继续进展提示预后较差。结论 IPA的胸部CT多具有诊断性特征病变,CT随访对观察病情演变和预后有重要意义。

Objective To evaluate the CT characteristics and prognostic value in invasive pulmonary aspergillosis （IPA）. Methods Sixty patients with IPA in whom aspergillus was found in sputum culture were seclected from 167 hos- pitalized patients with respiratory infection from January 2010 to march 2012. The chest CT imagings were analyzed retro- spectively. PEMS 3.1 medical statistics software for data analysis,count material were analyzed by X^2 test. Results Nodu- lar lesion was the most common finding on chest CT images, followed by cavitation, consolidation was the most rare feature. Halo sign was found in 68.3% of lesions. Most of nodular or mass lesions combined with halo sign at early stage （ at the first or second week）. Group A and group B comparison, infiltration shadow （ the forth week X2 = 4.82,P = 0.028 ; the fifth week X^2 = 9.0 ,P = 0. 003 ; the sixth week X^2 = 11.0, P = 0. 001 ） and cavitations （ the forth week X^2 = 4.81, P = 0. 028 ） were identified as statistically significant predictors of mortality. Crescent sign was found at late stage （ at the second or third week）. There were no statistically different of CT findings between hematological and non hematological groups. There were no further progress of most typical CT findings at third week and improved at the forth week after effective therapy. Consolidation and cavitation were identified as statistically significant predict factors of mortality. Conclusion Typical CT features can help to make diagnosis and prognosis early in patients suspected with IPA.