以磨玻璃影为首发改变的血液肿瘤伴肺部感染患者临床特征分析

Clinical analysis of grand glass opacity on CT as the first change of lung infection accompanied by hematologic malignancies

目的研究磨玻璃影（GGO）在早期诊断侵袭性肺部真菌感染（IPFI）中的意义。方法回顾性分析郑州大学附属肿瘤医院血液科2007年1月至2015年6月收治的143例CT以GGO为首发表现的肺部感染患者的临床资料，观察GGO及伴随的其他征象。结果男74例、女69例。83例急性白血病（AL），23例骨髓增殖异常综合征（MDS），18例非霍奇金淋巴瘤（NHL），10例多发性骨髓瘤（MM），9例霍奇金淋巴瘤（HL）。23例造血干细胞移植患者。90％（128／143）患者出现GGO改变时中性粒细胞减少或缺乏。GGO多伴随条索状炎性浸润影或结节。拟诊IPFI56例，临床诊断IPFI15例，确诊IPFI4例，未确定IPFI26例。92例抗真菌治疗有效。结论血液科胸部CT以GGO首发改变的肺部感染多发生在中性粒细胞缺乏或减少时期，多见于急性白血病或造血干细胞移植患者，胸部CT的GGO改变多提示肺部真菌感染可能，需及早给予抗真菌药物的应用。

Objective To evaluate the value of grand glass opacity （GGO） on CT as a diagnostic sign of pulmonary fungal infection. Methods The clinical data of 143 patients treated in department of hematology from January 2007 to June 2015 were analyzed retrospectively, and GGO or other attendant signs were observed. Results The cases of fungal infection secondary to acute leukemia （ AL）, myelodysplastic syndromes （ M DS ）, non- Hodgkin＇s lymphoma （ N HL）, multiple myeloma （ M M ）, Hodgkin＇ s lymphoma （ HL ） were 83, 23, 18, 10, 9, respectively, including 23 patients with hematopoietic stem cell transplantation. Ninety percent （128/143） of patients with GGO changes was accompanied with the presence of neutropenia. GGO was mostly accompanied by funicular inflammatory infiltrating shadows or nodules. The cases of possible invasive pulmonary fungal infections （ IPFI）, probable IPFI, proven IPFI, undefined IPFI were 56, 15, 4, 26, respectively. The total effective cases after anti-fungal therapy was 92. Conclusions Ground glass opacity as sign of pulmonary infection of CT mostly occurred in neutropenia and is more common in patients with acute leukemia or hematopoietic stem cell transplantation. GGO is a diagnostic sign of pulmonary fungal infection and it＇s indicating that anti-fungal medicine should be considered.