肺结核并发肺部真菌感染的CT表现特征分析

Analysis on Characteristics of CT Imaging in Pulmonary Tuberculosis Patients with Fungal Infection

目的探讨肺结核并发肺部真菌感染的CT表现特征，并进行观察分析。方法回顾性分析112例经病理组织学或细菌学，以及临床确诊的肺结核并发肺部真菌感染患者的CT表现特征，根据并发真菌感染的种类将患者分为曲霉菌组（61例）、念珠菌组（48例）、隐球菌组（3例），总结比较组间CT表现特征。结果肺结核并发常见真菌感染的发生率分别为曲霉菌组54．4％（61／112）、念珠菌组42．9％（48／1t2）、隐球菌组2．7％（3／112）。其中曲霉菌组与念珠菌组比较，各项临床症状（咳嗽、咯痰、发热、咯血丝痰、胸痛）差异均无统计学意义（P值均〉0．05）o肺结核并发真菌感染的CT表现常见斑片影96例（85．7％）、结节影95例（84．8％）、空洞影93例（83．0％）、树芽征改变74例（66．1％）、磨玻璃样密度影60例（53．6％）。念珠菌组与曲霉菌组肺部感染病灶累及肺叶较广，且曲霉菌组累及3个肺叶以上者（98．0％，47／48）明显多于念珠菌组（80．3％，49／61），差异有统计学意义（x。=7．91，P=0．005）。曲霉菌组在斑片影（93．4％，57／61）、空洞影（93．4％，57／61）、磨玻璃样密度影（63．9％，39／61）表现上较念珠菌组（77．1％，37／48；72．9％，35／48；39．6％，19／48）多见，而念珠菌组以树芽征（79．2％，38／48）、段性或大叶性实变影（39．6％，19／48）较曲霉菌组（59．0％，36／61；3．3％，2／61）多见，差异均有统计学意义（x2=6．06，P=0．014；x。=8．60，P=0．003；x2=6．40，P=0．011；x2=5．00，P=0．025；x2=22．76，P=0．000）。曲霉菌组中93．4％（57／61）的感染者可见曲菌球表现，其中37例为典型曲菌球。隐球菌组仅3例，均可见结节影，多位于胸膜下，且1例结节内可见内壁光滑的空洞。结论肺结核并发真菌感染有一定CT表现特征，CT扫描显示的图像特征有助于提示真菌感染的可能，具有一定的诊断价值。

Objective To investigate and analyze the characteristics of CT imaging in pulmonary tuberculosis patients with fungal infection. Methods We analyzed retrospectively characteristics of CT imaging in 112 cases with pulmonary tuberculosis complicated with fungal infection confirmed by pathology, bacteriology and clinical data. According to the species of fungal infections, they were divided into three groups of Aspergrillus （61 cases）, Candida （48 cases） and Cryptoloccus （3 cases）. The features of CT imaging were compared among three groups. Results The incidence rates in patients with pulmonary tuberculosis complicated with fungal infection were 54.4% （61/112） in the Aspergillus group, 42.9% （48/112） in Candida group and 2. 7% （3/112） in Cryptoloccus group.When compared Aspergillus group with Candida group, the differences in clinical symptoms including cough, expectoration, fever, blood streaked sputum and chest pain were no significant statistically （P〉0.05 for each）. The features of CT imaging showed patchy in 96 cases （85.7%）, nodule in 95 cases （84.8%）, cavity in 93 cases （83.0%）, tree-in-bud in 74 cases （66.1%） and ground glass opacity in 60 cases （53.6%）. There was a wide range of lobe involvement of pulmonary infection in the Candida group and Aspergillus group, and more than 3 lobes involvement （98.0%, 47/48） in the Aspergillus group were significantly higher than those in the Candida group （80. 3%, 49/61）, and the difference was statistically significant （x 2 = 7.91 , P = 0.005）. The incidence rates of patchy （93.4%, 57/61）, cavity （93.4%, 57/61） and ground glass opacity （63.9%, 39/61） in the Aspergillus group were higher than those （77.1%, 37/48 ; 72.9%, 35/48 ; 39.6%, 19/48） in the Candida group. However, the CT imaging with tree- in-bud （79.2% 38/48）, and segmental or lobar consolidation （39.6%, 19/48） in the Candida group were more common than those （59.0%, 36/61; 3.3%, 2/61） in the Aspergillus group. All differences for all features of CT imaging were significant statistically （ x 2 = 6.06, P = 0. 014; x 2 = 8.60, P = 0.003; x2 = 6.40, P = 0.011; x 2 = 5.00, P=0.025; x 2 =22.76, P=0.000）. There were 93.4% （57/61） cases showed signs of aspergilloma, especially typical signsin 37 cases. There were only 3 cases with Cryptococcus showed nodules located under pleura and there was cavity with smooth inner wall in one case. Conclusion There are some features of CT imaging in pulmonary tuberculosis complicated with fungal infection. It is diagnostic value to diagnose for fungal infection according to characteristics of CT scan.