胸部CT在肺结核合并真菌感染诊断中的价值

The value of chest CT in the diagnosis of pulmonary tuberculosis complicated by fungal infection

目的:探讨胸部CT在肺结核合并真菌感染诊断中的价值,为肺结核合并真菌感染的早期诊断提供依据.方法:选取2013-01/2014-06广东省汕头市澄海区人民医院收治的经病理和临床检查确诊为肺结核的300例患者作为研究对象,采用GE公司Light Speed 16层CT机进行胸部CT检查.结果:本组患者CT表现为病灶位于左肺90例,右肺100例,双肺110例;累及单个肺叶120例,两个肺叶同时受累125例,三个及以上肺叶受累55例;多发小斑片状阴影85例,支气管肺炎型90例,大叶性肺炎型50例,粟粒型40例,局灶型25例,腐生型10例.病灶钙化130例,其中单发50例,多发80例;伴有胸膜粘连、增厚55例,胸腔积液40例,胸膜钙化20例.并发肺气肿65例、气管扩张症55例.确诊肺结核合并肺部真菌感染30例,其中白色假丝酵母菌25例,热带假丝酵母菌3例,光滑假丝酵母菌2例.肺结核合并真菌感染者两个肺叶受累的比例为83.3%,高于未合并真菌感染者的37.0%,差异具有统计学意义(P<0.05);显示有空洞者的比例为33.3%,高于未合并真菌感染者的6.7%,差异具有统计学意义(P<0.05);显示支气管播散者的比例为60.0%,高于未合并真菌感染者的26.7%,差异具有统计学意义(P<0.05);显示胸腔积液者的比例为40.0%,高于未合并真菌感染者的10.3%,差异具有统计学意义(P<0.05).结论:肺结核合并真菌感染者的CT多显示双肺弥漫性病变,且以弥漫性小叶分布、大叶实变及跨肺叶浸润为主要特征,胸部CT检查有助于肺结核合并真菌感染者的诊断.

AIM： To investigate the value of chest CT in the diagnosis of pulmonary tuberculosis complicated by fungal infection and provide a basis for early diagnosis of pulmonary tuberculosis complicated by fungal infection. METHODS： A total of 300 cases of pulmonary tuberculosis through pathological and clinical examination admitted into People＇s Hospital of Chenghai from January 2013 to June 2014 were selected as the research objects.The GE Lightspeed 16-slice CT machine was adopted to perform the chest CT examination. RESULTS： The CT images showed that lesions developed at the left lung in 90 cases,right lung in100 cases,both lungs in 110 cases; a single lobe was involved in120 cases,two lobes in 125 cases,three or more lobes in 55cases; multiple small patchy shadows in 85 cases, bronchial pneumonia type in 90 cases,lobar pneumonia type in 50 cases,nodal type in 40 cases,focal type in 25 cases,saprophytes type in 10 cases. Calcification of lesions was found in 130 cases,in which single lesion in 50 cases,multiple lesions in 80 cases; It＇s accompanied by pleural adhesion,thickening in 55 cases,pleural effusion in 40 cases,pleural calcification in 20 cases. It＇s complicated by emphysema in 65 cases,bronchiectasis in 55 cases. A total of 30 cases were diagnosed as pulmonary tuberculosis complicated by pulmonary fungal infection,including 25 cases of Candida albicans,3 cases of Candida tropicalis,2 cases of Candida glabrata. The ratio of two lobe involvement of patients with pulmonary tuberculosis complicated by fungal infection was 83. 3%,which was higher than non-fungal infection patients（ 37.0%）,and the difference was statistically significant（ P〈0. 05）; The ratio of cavity was 33.3%,which was higher than that of the non-fungal infection patients（ 6. 7%）,and the difference was statistically significant（ P〈0. 05）; The ratio of bronchus dissemination was60.0%,which was higher than that of the non-fungal infection patients（ 26. 7%）,and the difference was statistically significant（ P〈0.05）; The ratio of pleural effusion was 40.0%,which was higher than that of the non-fungal infection patients（ 10.3%）,and the difference was statistically significant（ P〈0. 05）. CONCLUSION： The CT images of patients with pulmonary tuberculosis complicated by fungal infection mostly show bilateral pulmonary diffuse lesion,and it is characterized by diffuse lobular distribution,the lobar consolidation and cross-lobe infiltration. The chest CT examination contribute to the diagnosis of pulmonary tuberculosis complicated by fungal infection.