多层螺旋CT在侵袭性肺曲霉菌感染病情和预后预测的价值分析

发布时间：2018-05-18 23:45

本文选题：多层螺旋CT + 侵袭性肺曲霉菌　；参考：《中华医院感染学杂志》2017年09期

【摘要】：目的观察和分析多层螺旋CT(MSCT)在侵袭性肺曲霉菌感染病情和预后预测中的价值,为制定合理临床诊疗方案提供客观依据。方法选取2014年3月-2016年7月的疑似侵袭性肺曲霉菌感染患者80例为研究对象,确诊为侵袭性肺曲霉菌感染59例,以病理学及痰培养为诊断金标准,对MSCT在侵袭性肺曲霉菌感染诊断中的价值进行评价;对确诊为侵袭性肺曲霉菌感染患者的病灶部位分布进行观察和分析;对合并侵袭性肺曲霉菌感染的血液病与非血液病患者的MSCT征象进行观察和比较;对所有确诊患者进行为期6周的随访,将临床症状明显改善患者列为预后良好组,将临床症状恶化或死亡的患者列为预后不良组,对两组患者治疗前及治疗6周时的MSCT表现进行分析和比较。结果 MSCT诊断侵袭性肺曲霉菌感染的灵敏度为93.2%、特异度为76.2%、阳性预测值为91.7%、阴性预测值为80.0%;侵袭性肺曲霉菌感染患者MSCT下病灶部位多为双肺多发,占42.4%,在肺叶分布中,以上叶分布为主,占55.9%,外周带分布较多,占69.5%;合并侵袭性肺曲霉菌感染的血液病患者的实变影和团块影的分布率显著高于非血液病患者,差异有统计学意义(P0.05);在治疗6周时,预后不良组患者各类MSCT征象的出现率均高于预后良好组,差异均有统计学意义(P0.05)。结论 MSCT在侵袭性肺曲霉菌感染辅助诊断中具有一定价值,患者的CT征象与其基础疾病、预后情况具有一定的相关性,可作为评价病情和预测预后的辅助手段。
[Abstract]:Objective to observe and analyze the value of MSCT in predicting the condition and prognosis of invasive pulmonary aspergillosis, and to provide an objective basis for rational clinical diagnosis and treatment. Methods from March 2014 to July 2016, 80 patients with suspected invasive pulmonary aspergillus infection were selected as study subjects, 59 patients were diagnosed as invasive pulmonary aspergillus infection, pathology and sputum culture were used as diagnostic gold criteria. To evaluate the value of MSCT in the diagnosis of invasive pulmonary aspergillus infection, to observe and analyze the location distribution of the lesions in the patients with invasive pulmonary aspergillus infection. The MSCT signs of patients with invasive pulmonary aspergillosis were observed and compared with those of non-hematological patients, and all the patients were followed up for 6 weeks, and the patients with improved clinical symptoms were classified as the group with good prognosis. The MSCT findings of the two groups before treatment and 6 weeks after treatment were analyzed and compared. Results the sensitivity, specificity, positive predictive value and negative predictive value of MSCT in the diagnosis of invasive pulmonary Aspergillus pneumoniae infection were 93.22.The positive predictive value was 91.7and the negative predictive value was 80.0.The lesions under MSCT of invasive pulmonary aspergillus infection patients had multiple lesions in both lungs (42.4%). The distribution of the above lobes was dominant (55.9%), and the distribution of peripheral zones was more (69.5%). The distribution rates of solid and mass shadows in patients with invasive pulmonary aspergillosis were significantly higher than those in non-hematological patients (P 0.05), and at 6 weeks after treatment, the distribution rates of solid and mass shadows were significantly higher in patients with invasive pulmonary aspergillosis than in patients with non-hematological diseases (P 0.05). The incidence of various MSCT signs in patients with poor prognosis was higher than that in patients with good prognosis (P 0.05). Conclusion MSCT has a certain value in the auxiliary diagnosis of invasive pulmonary aspergillus infection. The CT findings of the patients have a certain correlation with their underlying diseases and prognosis, which can be used as an auxiliary means to evaluate the condition of the disease and predict the prognosis.
【作者单位】：武警吉林总队医院放射线科;
【基金】：吉林省卫生厅科研基金资助项目(2014ZC007)
【分类号】：R519;R816.41

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