侵袭性肺曲霉菌感染的螺旋CT特征与预后分析

Features of spiral CT of patients with invasive pulmonary Aspergillus infections and analysis of prognosis

目的调查侵袭性肺曲霉菌感染的多层螺旋CT(MSCT)特征及预后演变,为临床诊疗提供指导。方法选择2012年2月-2015年2月60例拟诊为侵袭性肺曲霉菌感染者为研究对象,观察MSCT对侵袭性肺曲霉菌感染的诊断效力,观察其MSCT特征,根据患者预后分为治愈好转组与恶化死亡组,观察并比较治疗前、治疗3周及治疗6周时患者胸部MSCT演变;采用SPSS11.0软件进行统计分析。结果 MSCT对侵袭性肺曲霉菌感染的诊断灵敏度93.3%、特异度80.0%、阳性预测率93.3%、阴性预测率80.0%、正确率73.3%、误诊率20.0%、漏诊率6.7%及诊断符合率90.0%;侵袭性肺曲霉菌感染病灶以双肺多发为主,上叶多见,外周带比例最高;侵袭性肺曲霉菌感染肺部CT征象包括斑片影、实变影、团块影、结节灶、空洞、星月征、枝桠征及晕轮征;血液病与非血液病患者侵袭性肺曲霉菌感染MSCT征象中,血液病患者实变占25.9%及团块影占59.3%的比例均显著高于非血液病患者,差异有统计学意义(P<0.05);治疗3周后,治愈好转组渗出病变的比例显著低于恶化死亡组,差异有统计学意义(P<0.05),治疗6周后,治愈好转组渗出、结节及空洞病灶的比例均显著低于恶化死亡组,差异有统计学意义(P<0.05)。结论侵袭性肺曲霉菌感染MSCT图像具有特征性,并可以评估病情演变及预后。

OBJECTIVE To investigate the features of multislice spiral CT（MSCT）of invasive pulmonary Aspergillus infections and observe the evolution of prognosis so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 60 patients with suspected invasive pulmonary Aspergillusinfections were recruited as the study objects.The effectiveness of the MSCT in diagnosis of the invasive pulmonary Aspergillusinfections was observed,and the features of the MSCT were observed.The enrolled patients were divided into the cured and improved group and the deterioration and death group according to the prognosis of the patients.The features of the chest MSCT were observed before the treatment,or 3weeks,6weeks after the treatment;the statistical analysis was performed with the use of SPSS11.0software.RESULTS The sensitivity of the MSCT in the diagnosis of the invasive pulmonary Aspergillus infections was 93.3%,the specificity 80.0%,the positive predictive value93.3%,the negative predictive value 80.0%,the accuracy 73.3%,the misdiagnosis rate 20.0%,the rate of missed diagnosis 6.7%,the accordance rate of diagnosis 90.0%.The double lungs with the invasive pulmonary Aspergillus infections were dominant,superior lobes were more common,and the proportion of the peripheral zone was the highest.The signs of the lung CT of the patients with invasive pulmonary Aspergillus infections included the spot films,consolidation shadows,mass shadows,nodules,voids,Xingyue sign,branches sign,and halo sign.According to the MSCT signs of the patients with invasive pulmonary Aspergillus infections,the blood diseases patients with consolidation shadows accounted for 25.9%,significantly higher than that of the non-blood diseases patients;the blood diseases patients with mass shadows accounted for 59.3%,significantly higher than that of the non-blood diseases patients（P〈0.05）.The proportion of the patients with exudative lesions was significantly lower in the cured and improved group than in the deterioration and death group after the treatment for 3weeks（P〈0.05）;the proportion of the patients with exudative,nodule,or cavity lesions was significantly lower in the cured and improved group than in the deterioration and death group（P〈0.05）.CONCLUSION The MSCT features of the patients with invasive pulmonary Aspergillusinfections are unique,which may contribute to the evaluation of the evolution of illness condition and the prognosis.