恶性血液病患者医院感染肺部CT影像学特征及对预后的评估

发布时间：2018-03-27 17:11

本文选题：恶性血液病　切入点：医院感染　出处：《中华医院感染学杂志》2017年19期

【摘要】：目的探究恶性血液病患者医院感染的肺部CT表现及对预后的评估。方法选取2012年2月-2016年2月来本院诊治恶性血液病患者252例,将发生院内真菌感染(HFI)的70例为研究对象作为真菌组,广谱抗菌药物有效患者85例作为细菌组。分析患者病原菌的分布及变迁情况,研究患者发生真菌感染时的临床症状、体征、感染器官的影像学特征及其功能变化、抗真菌药的疗效。结果 252例恶性血液病患者,有70例发生HFI,感染率为27.78%,感染部位以呼吸道为主。肺部阳性发生率为35.71%;HFI患者肺CT表现磨玻璃密度影发生率为41.43%低于细菌组62.35%(P0.05),同时,大结节直径1cm、空洞、晕征、毛刺征、高密度团块影与新月征均出现在真菌组,而细菌组无出现,差异显著(P0.05);单一用药有效率73.33%低于联合用药的75%,但差异无统计学意义,同时各联合用药间对比差异无统计学意义;在治疗过程中,发现真菌组肺CT表现加重率为21.43%显著高于细菌组5.88%(P0.01)。结论对于恶性血液病患者医院感染,积极根据患者的肺部CT表现可以有效提高医院真菌感染诊断率,并改善预后情况。
[Abstract]:Objective to investigate the lung CT findings and prognosis of nosocomial infection in patients with malignant hematological diseases. Methods 252 patients with malignant hematological diseases were treated from February 2012 to February 2016. Seventy patients with nosocomial fungal infection (HFI) and 85 patients with effective broad-spectrum antimicrobial agents were used as fungal group and bacterial group respectively. The distribution and changes of pathogenic bacteria were analyzed, and the clinical symptoms of fungal infection were studied. Signs, imaging features and functional changes of infected organs, curative effects of antifungal agents. Results 252 patients with malignant hematopathy, There were 70 cases of HFI, the infection rate was 27.78%, the main infection site was respiratory tract. The positive rate of lung CT findings of HFI patients was 41.43% lower than that of bacteria group (62.3535 P0.05). Meanwhile, the diameter of large nodule was 1 cm, cavity, halo sign, burr sign. High density mass shadow and crescent sign appeared in fungi group, but bacteria group did not appear, the difference was significant (P 0.05), the effective rate of single drug was 73.33% lower than that of combined drug 75, but the difference was not statistically significant, and there was no significant difference between the two groups. In the course of treatment, it was found that the exacerbation rate of pulmonary CT manifestations in fungal group was 21.43%, significantly higher than that in bacteria group (5.88%, P 0.01). Conclusion for nosocomial infection of patients with malignant hematologic diseases, the positive CT findings of the patients can effectively improve the diagnosis rate of nosocomial fungal infection. And improve the prognosis.
【作者单位】：海南医学院第二附属医院放射科;
【分类号】：R733;R816.4

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