肺结核患者真菌感染的CT影像特点研究

发布时间：2018-07-13 18:30

【摘要】：目的探讨肺结核并发真菌感染患者的CT影像学诊断特点及临床价值。方法分析2011年6月-2016年6月于医院治疗的392例肺结核患者的临床资料,根据ATS真菌感染专家组发布的成人呼吸与重症监护患者真菌感染治疗指南,从392例肺结核患者中选出合并真菌感染的患者。将患者分为观察组(肺结核合并真菌感染)和对照组(肺结核未合并真菌感染);记录患者治疗前后的临床资料,对两组患者进行X线及CT检查,观察两组患者的影像学特征。结果观察组真菌培养率为100.0%,共检测出85株真菌,其中白假丝酵母、隐球菌、曲霉菌、热带假丝酵母以及光滑假丝酵母分别占38.8%、31.8%、9.4%、8.2%及7.0%;肺结核合并真菌感染诊断方法中,CT检查阳性率达72.9%,明显高于X线检查阳性率11.8%,两者差异有统计学意义(P0.05);结合细菌学培养结果绘制ROC曲线,CT检查的AUC为0.792,X线的曲线下面积为0.673,提示CT检查诊断准确性更高;比较两组患者的CT影像学表现,肺结核合并真菌感染累及两个肺叶比例达82.4%,远高于对照组患者,差异有统计学意义(P0.05);观察组存在空洞的患者达32.9%,存在胸腔积液及支气管散播的患者达40.0%及60.0%,远高于对照组患者(P0.05)。结论肺结核合并真菌感染患者的CT影像学检查阳性率高,密度分辨率和空间分辨率都较高,多呈现双肺弥漫性病变,优于常规X线检查,有助于临床上检查肺结核合并感染的诊断。
[Abstract]:Objective to investigate the CT imaging features and clinical value of pulmonary tuberculosis complicated with fungal infection. Methods the clinical data of 392 patients with pulmonary tuberculosis treated in hospital from June 2011 to June 2016 were analyzed. According to the guidelines for the treatment of fungal infections in adult respiratory and intensive care patients issued by the ATS expert Group on fungal infection, Patients with fungal infection were selected from 392 patients with pulmonary tuberculosis. The patients were divided into observation group (pulmonary tuberculosis with fungal infection) and control group (pulmonary tuberculosis without fungal infection), the clinical data before and after treatment were recorded, and X-ray and CT examinations were performed to observe the imaging characteristics of the two groups. Results the culture rate of fungi in the observation group was 100.00.A total of 85 fungi were detected, including Candida albicans, Cryptococcus albicans, Aspergillus sp. Candida tropicalis and Candida tropicalis accounted for 8.2% and 7.0%, respectively. The positive rate of CT examination was 72.9% in the diagnosis of pulmonary tuberculosis complicated with fungal infection, which was significantly higher than the positive rate of X-ray examination (11.8%) (P0.05), combined with bacteriology, the positive rate of CT examination was significantly higher than that of X-ray examination (P0.05), and the positive rate of CT examination was significantly higher than that of X-ray examination (P0.05). The area under the curve of ROC curve drawn by CT was 0.773, which indicated that the diagnostic accuracy of CT was higher than that of CT. Comparing the CT findings of the two groups, the ratio of pulmonary tuberculosis with fungal infection to the two lobes was 82.4%, which was much higher than that of the control group. The difference was statistically significant (P0.05); in the observation group there were 32. 9% of the patients with cavity, 40. 0% of the patients with pleural effusion and 60. 0% of the bronchus spread, much higher than the control group (P0.05). Conclusion the positive rate of CT imaging examination, density resolution and spatial resolution of pulmonary tuberculosis patients with fungal infection are high, and most of them present diffuse lesions of both lungs, which is superior to conventional X-ray examination. It is helpful for clinical diagnosis of pulmonary tuberculosis complicated with infection.
【作者单位】：河池市人民医院放射科;
【分类号】：R519;R521;R816.41

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