慢性重型肝炎患者侵袭性肺部真菌感染的CT影像学特征分析

Clinical CT imaging features of invasive pulmonary fungal infections in patients with chronic severe hepatitis

目的探讨慢性重型肝炎患者侵袭性肺部真菌感染的临床CT影像学特征,为慢性重型肝炎侵袭性肺部真菌感染患者临床诊治提供参考依据。方法选择医院2010年1月-2013年12月临床收治的慢性重型肝炎并发侵袭性肺部真菌感染患者114例为研究对象,根据患者临床治疗方法不同,将其分为对照组和研究组,每组各57例;对照组患者给予甘利欣、丹参注射液、促肝细胞生长素、血制品等常规治疗,研究组患者在对照组治疗的基础上采用氟康唑治疗,观察和比较两组患者病原菌分布特征及治疗前后CT影像学特征。结果 114例患者共检出病原菌218株,其中假丝酵母菌属93株、曲霉菌属75株及组织胞浆菌39株,分别占42.66%、34.40%及17.89%;治疗前,两组患者CT影像学特征分布率比较,差异无统计学意义,治疗后,研究组的CT影像学特征改善效果明显,患者出现CT影像学特征分布率明显低于对照组,差异有统计学意义(P<0.05);治疗前CT平扫可见双肺多发斑片状密度增高影,边缘模糊,治疗后CT平扫显示,双肺病灶密度及范围较治疗前明显改善。结论慢性重型肝炎并发侵袭性肺部真菌感染患者的病原菌以假丝酵母菌属和曲霉菌属为主,患者的临床CT影像学特征主要表现为结节和磨玻璃影,患者给予氟康唑治疗后的临床效果较好。

OBJECTIVE To explore the clinical CT imaging features of invasive pulmonary fungal infections for patients with chronic severe hepatitis,so as to provide reference basis for the diagnosis and treatment.METHODS A total of 114 cases with chronic severe hepatitis and invasive pulmonary fungal infections from Jan.2010 to Dec.2013 in our hospital were chosen as the research objects.According to the different clinical treatment methods,the patients were divided into study group（with fluconazole therapy）and control group（with conventional therapy）,with 57 cases in each group.The pathogen distribution and CT imaging features before and after treatment of the two groups were observed and compared.RESULTS Totally 218 strains of pathogens were detected in the 114 cases,including 93 strains of Candida,75 strains of Aspergillus,39 strains of Histoplasma,accounting for42.66%,34.40%,and 17.89%,respectively.The distribution of CT imaging characteristics of patients between the groups had no significant differences before treatment.After treatment,improvement effect of CT imaging characteristics in study group was obvious,the proportion of patients with CT imaging features was significantly lower than control group（χ^2=7.9573,P=0.0048）.Before treatment,CT imaging results showed patchy clouding opacity and marginal haziness,and the density and range of lesions were significantly improved after treatment.CONCLUSIONThe pathogens of invasive fungal infections in patients with chronic severe hepatitis are mainly Candidaand Aspergillus,the clinical CT imaging characteristics are mainly nodules and ground-glass opacity,and the clinical effect of fluconazole is better after treatment.