侵袭性肺曲霉菌感染MSCT图像及预后分析

发布时间：2018-05-17 05:24

本文选题：侵袭性肺曲霉菌感染 + 螺旋CT　；参考：《中华医院感染学杂志》2017年02期

【摘要】：目的探讨侵袭性肺曲霉菌感染多层螺旋CT(MSCT)图像特点及预后情况,为临床医师诊治提供参考。方法选取2014年5月-2016年5月82例侵袭性肺曲霉菌感染者纳入本研究,所有患者均采用MSCT检查、诊断,所有患者均采用伏立康唑针剂静脉滴注,首日6mg/kg,每12小时1次;之后4mg/kg,每12小时1次;序贯伏立康唑片口服,4mg/kg,每12小时1次治疗;疗程根据患者临床表现及实验室指标等决定;根据患者预后将其分为无效组(20例)与有效组(62例);分别于治疗前、治疗3、6周时采用MSCT检查其胸部影像变化,计算MSCT诊断侵袭性肺曲霉菌的诊断准确度、特异度、灵敏度、阳性预测值及阴性预测值。结果 MSCT诊断侵袭性肺曲霉菌的诊断准确度、特异度、灵敏度、阳性预测值及阴性预测值分别为80.49%、81.25%、80.00%、86.96%、72.22%;血液患者MSCT影像中,实变、团块影比率明显高于非血液病患者(P0.05);患者感染病灶主要以双肺多发为主,且以上叶多见,外周带比率较高;CT征象:结节灶、实变影、团块影、斑片影、空洞、晕轮征等;经治疗3周后,有效组渗出病变率明显低于无效组(P0.05);经治疗6周后,有效组渗出和结节及空洞病灶率明显低于无效组(P0.05)。结论采用MSCT诊断侵袭性肺曲霉菌感染可为患者临床预后、病情评估提供一定参考。
[Abstract]:Objective to investigate the imaging features and prognosis of multilayer spiral CTT (MSCT) in invasive pulmonary aspergillosis and to provide reference for clinicians. Methods from May 2014 to May 2016, 82 patients with invasive pulmonary aspergillus infection were included in this study. All patients were examined and diagnosed by MSCT, and all patients were injected with Volconazole injection intravenously, 6 mg / kg every 12 hours on the first day. Then 4 mg / kg, once every 12 hours, and 4 mg / kg, once every 12 hours. The course of treatment was determined according to the clinical manifestation of the patients and the laboratory indexes. According to the prognosis of the patients, the patients were divided into two groups: the ineffective group (n = 20) and the effective group (n = 62). The chest imaging changes were examined by MSCT after 36 weeks of treatment, respectively, and the diagnostic accuracy, specificity and sensitivity of MSCT in the diagnosis of invasive pulmonary aspergillus were calculated. Positive predictive value and negative predictive value. Results the diagnostic accuracy, specificity, sensitivity, positive predictive value and negative predictive value of MSCT in the diagnosis of invasive pulmonary aspergillus were 80.49 and 81.25, respectively. The mass shadow ratio was significantly higher than that in non-hematological patients (P 0.05), and the main infection foci were multiple pulmonary lesions, and most of the above lobes were found in the above lobes. The peripheral zone ratio was higher than that in the non-hematological patients. The CT signs included nodular focus, solid shadow, mass shadow, speckle shadow, cavity, halo sign and so on. After 3 weeks of treatment, the rate of exudative lesions in the effective group was significantly lower than that in the ineffective group, and after 6 weeks of treatment, the rates of exudation and nodule and cavity focus in the effective group were significantly lower than those in the ineffective group. Conclusion the diagnosis of invasive pulmonary aspergillus infection by MSCT can provide some reference for clinical prognosis.
【作者单位】：绍兴市第七人民医院放射科;绍兴市人民医院浙江大学绍兴医院放射科;辉瑞(北京)国际医学院临床药学研究中心;
【基金】：浙江省医学会临床科研资金项目(2011zyc-B04)
【分类号】：R519;R816.4

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