本文選題：侵襲性肺曲霉菌感染 + 螺旋CT��； 參考：《中華醫(yī)院感染學(xué)雜志》2017年02期

【摘要】：目的探討侵襲性肺曲霉菌感染多層螺旋CT(MSCT)圖像特點(diǎn)及預(yù)后情況,為臨床醫(yī)師診治提供參考。方法選取2014年5月-2016年5月82例侵襲性肺曲霉菌感染者納入本研究,所有患者均采用MSCT檢查、診斷,所有患者均采用伏立康唑針劑靜脈滴注,首日6mg/kg,每12小時(shí)1次;之后4mg/kg,每12小時(shí)1次;序貫伏立康唑片口服,4mg/kg,每12小時(shí)1次治療;療程根據(jù)患者臨床表現(xiàn)及實(shí)驗(yàn)室指標(biāo)等決定;根據(jù)患者預(yù)后將其分為無效組(20例)與有效組(62例);分別于治療前、治療3、6周時(shí)采用MSCT檢查其胸部影像變化,計(jì)算MSCT診斷侵襲性肺曲霉菌的診斷準(zhǔn)確度、特異度、靈敏度、陽性預(yù)測值及陰性預(yù)測值。結(jié)果 MSCT診斷侵襲性肺曲霉菌的診斷準(zhǔn)確度、特異度、靈敏度、陽性預(yù)測值及陰性預(yù)測值分別為80.49%、81.25%、80.00%、86.96%、72.22%;血液患者M(jìn)SCT影像中,實(shí)變、團(tuán)塊影比率明顯高于非血液病患者(P0.05);患者感染病灶主要以雙肺多發(fā)為主,且以上葉多見,外周帶比率較高;CT征象:結(jié)節(jié)灶、實(shí)變影、團(tuán)塊影、斑片影、空洞、暈輪征等;經(jīng)治療3周后,有效組滲出病變率明顯低于無效組(P0.05);經(jīng)治療6周后,有效組滲出和結(jié)節(jié)及空洞病灶率明顯低于無效組(P0.05)。結(jié)論采用MSCT診斷侵襲性肺曲霉菌感染可為患者臨床預(yù)后、病情評估提供一定參考。
[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.
【作者單位】： 紹興市第七人民醫(yī)院放射科;紹興市人民醫(yī)院浙江大學(xué)紹興醫(yī)院放射科;輝瑞(北京)國際醫(yī)學(xué)院臨床藥學(xué)研究中心;
【基金】：浙江省醫(yī)學(xué)會臨床科研資金項(xiàng)目(2011zyc-B04)
【分類號】：R519;R816.4

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