肺部CT联合血清半乳甘露聚糖实验在白血病并发侵袭性肺曲霉菌病诊断及疗效评价中的应用

The diagnosis and therapeutic evaluation of invasive pulmonary aspergillosis in leukemia patients using CT combined with galactomannan test

目的探讨肺部CT联合血清半乳甘露聚糖实验在白血病并发侵袭性肺曲霉菌病诊断及疗效评价中的应用价值。方法对我院2010年1月~2012年12月期间,收集临床诊断为IPA的白血病患者25例,回顾性分析其CT影像和GM实验。结果 CT表现出现结节及晕征17例,出现楔形实变影3例,弥漫分布粟粒或小结节模糊影4例;1例表现为两肺散在斑片影伴周围'卫星灶'。15例抗真菌治疗有效,治疗过程中GM值降低至正常;8例进展、GM值升高,之后调整抗真菌治疗方案有效、GM值降低;2例患者感染无法控制,GM值上升或虽有下降但一直处于阳性水平。结论肺部CT检查联合血清半乳甘露聚糖(GM)实验可监测临床诊断侵袭性肺曲霉病(IPA)的疗效。

Objective To investigate the role of chest CT image combine serum galactomannan(GM)test as predictors of therapeutic effect in leukemia patients with invasive pulmonary aspergillosis(IPA).Methods In this retrospective study from Jan 2010 to Dec 2012,we analyzed both of chest CT image and GM test in 25 patients classified as 'clinical diagnosis' IPA.Result Chest CT image had four kinds of manifestations:nodules with halo sign(17cases),wedge-shaped consolidation(3cases),diffuse lesser tubercle(4cases)and scattered patchy shadows with satellite lesions(1case).Antifungal treatment was effectivein 15 cases with GM index being down to normal at the same time.In 8cases in progress,GM index raised accordingly;when new antifungal therapy was accepted and worked well,the GM index was lower down.In 2cases of inflammation out of control,GM index was positive constantly.Conclusion Chest CT image combine serum GM test can be considered as a valuable tool to monitoring treatment effect in leukemia patient with IPA.