不同免疫抑制状态下侵袭性肺曲霉菌病的CT影像对比研究

Contrast Study of CT Images of Invasive Pulmonary Aspergillus Infection in Different Immunosuppression States

目的比较研究侵袭性肺曲霉菌病(IPA)在不同免疫抑制状态的CT影像表现。方法搜集本院2016年6月至2019年12月间收治的IPA患者27例,分成HIV感染致重度免疫缺陷/免疫丧失组(11例)和其他基础疾病致轻度免疫抑制组(16例),分析两组的胸部CT表现。结果 HIV感染组中出现支气管扩张/壁增厚者4例、气管周围渗出者7例,多于其他疾病组(0例、2例),有统计学差异(P=0.06;P=0.02)。实性结节/肿块、结节周围"晕轮征"、肺内实变在其他疾病组(11例、8例、11例)多于HIV感染组(3例、0例、4例),有统计学差异(P=0.034;P=0.01;P=0.034)。结论肺曲霉菌气管侵袭更容易出现在免疫力重度受损的HIV感染患者,血管侵袭在其他疾病导致的轻度免疫受损患者中较为多见。

Objective To compare CT imaging findings of invasive pulmonary aspergillosis in different immunosuppressive states. Methods Twenty-seven patients with pulmonary invasive aspergillosis admitted to our hospital from June 2016 to December 2019 were collected and divided into a severe immunodeficiency/immunity loss group(11 cases) caused by HIV infection and a mild immunosuppression group caused by other basic diseases(16 cases),the chest CT appearance of the two groups was analyzed. Results There were 4 cases of bronchiectasis/wall thickening and 7 cases of peripheral airway exudation in the HIV infection group, which were more than other disease groups(0 cases, 2 cases),with statistical differences(P=0.06;P=0.02). Solid nodules/mass, halo sign around nodules, pulmonary consolidation are more frequent in other disease groups(11 cases, 8 cases, 11 cases) than HIV infection groups(3 cases, 0 cases, 4 cases),there are statisticallysignificant differences(P=0.034;P=0.01;P=0.034). Conclusion Airway invasion of Aspergillus pneumoniae is more likely to occur in HIV-infected patients with severely impaired immunity. Vascular invasion is more common in patients who are mildly immunocompromiseddue to other diseases.