肿瘤化疗患者医院感染肺部CT影像学特征

Lung CT imaging features of tumor patients with nosocomial infection undergoing chemotherapy

目的探讨肿瘤化疗患者医院感染肺部电子计算机断层扫描(CT)影像学特征及对预后的评估,为临床病情分析与预测提供依据。方法选择2014年6月-2016年6月医院接诊的肿瘤化疗患者959例,其中发生医院感染患者共304例为研究对象,按照其感染病原体的不同分为真菌组50例与细菌组254例,对两组患者的感染部位、临床症状及感染器官的影像学特点进行观察,对真菌组不同治疗方案治疗效果进行研究。结果 959例肿瘤化疗患者发生医院感染患者304例,感染率为31.70%,其中真菌感染50例,细菌感染254例。真菌组患者肺部感染检出率为42.00%(21/50)低于细菌组51.57%(131/254)(P=0.216);细菌组患者发热、咳血或痰中带血发生率为94.49%(240/254)、26.38%(67/254)高于真菌组患者(P<0.05)。CT影像显示,真菌组患者磨玻璃密度影、毛刺征、胸腔积液、大结节直径>1cm、多发小结节影或近胸膜小结节检出率分别为42.00%(21/50)、14.00%(7/50)、54.00%(27/50)、48.00%(24/50)、56.00%(28/50)与细菌组比较差异有统计学意义(P<0.05)。真菌组联合治疗有效率高于单药治疗效果,但差异无统计学意义;联合治疗两两比较差异无统计学意义(P=0.182)。结论对于肿瘤化疗医院感染患者,可早期应用CT影像学检查,根据其特征实现早发现、早诊断、早治疗,以更早控制感染和改善预后,联合用药具有一定的临床价值。

OBJECTIVE To explore the lung computed tomography（CT）imaging features of tumor patients with nosocomial infection undergoing chemotherapy and evaluate the prognosis so as to provide guidance for prediction of clinical outcomes.METHODS A total of 959 patients who received chemotherapy in the hospital from Jun 2014 to Jun 2016 were enrolled in the study,304 of whom had nosocomial infection and were recruited as the study objects and divided into the fungi group with 50 cases and the bacteria group with 254 cases according to the species of pathogens.The the infection sites,clinical symptoms and imaging characteristics of infected organs were observed,and the treatment effects of the fungi group were studied.RESULTS Of the 959 tumor patients who received chemotherapy,304 had nosocomial infection,with the infection rate 31.70%,50 of whom had fungal infection,and 254 had bacterial infection.The detection rate of pulmonary infection of the fungi group was 42.00%（21/50）,lower than 51.57%（131/254）of the bacteria group（P=0.216）.The incidence rates of fever,hemoptysis or blood-stained sputum of the bacteria group were respectively 94.49%（240/254）and 26.38%（67/254）,significantly higher than those of the fungi group（P〈0.05）.The CT imaging findings showed that the detection rates of ground-glass opacity,spicule sign,pleural effusion,diameter of lar nodule more than 1 cm and multiple nodules or proximal pleural nodules of the fungi group were respectively 42.00%（21/50）,14.00%（7/50）,54.00%（27/50）,48.00%（24/50）and 56.00%（28/50）,significantly lower than those of the bacteria group（P〈0.05）.In the fungi group,the effective rate of combined drug therapy was higher than that of the single drug therapy,but there was no significant difference;there was no significant difference in the combined drug therapy between the two groups（P=0.182）.CONCLUSIONThe CT imageological examination may facilitate the early identification,early diagnosis and early treatment of the tumor patients with nosocomial infection undergoing chemotherapy so as to control the infection in early stage and improve the prognosis,and the combined drug therapy has certain clinical value.