儿童异基因造血干细胞移植术后肺急性移植物抗宿主病与感染CT表现

目的 观察儿童异基因造血干细胞移植（allo-HSCT）术后肺部急性移植物抗宿主病（aGVHD）的CT表现，并与感染性病变鉴别。方法 纳入148例allo-HSCT后出现肺部病变患儿，分为aGVHD组（n=85）和感染组（n=63）。比较组间年龄、术后发病时间及肺部CT征象及分布模式差异。结果 aGVHD组与感染组年龄与发病时间差异均具有统计学意义（P均<0.05）。aGVHD组常见CT征象为磨玻璃影（GGO，35/85，41.18%）、实变影（14/85，16.47%）及胸腔积液（12/85，14.12%），多呈双侧、弥漫分布，可见胸膜下空逸；感染组常见征象包括实变影（33/63，52.38%）、GGO（32/63，50.79%）及支气管壁增厚（23/63，36.51%），多呈单侧、局限性分布；2组病变分布模式差异均具有统计学意义（P均<0.05）。支气管壁增厚多见于感染组（P<0.05）。结论 儿童肺aGVHD的CT表现具有特征性，结合发病时间等信息可与感染性病变相鉴别。

CT features of acute pulmonary graft-versus-host disease and infections after allogeneic hematopoietic stem cell transplantation in children

Objective To observe the CT features of lung acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children, and to distinguish aGVHD with infectious diseases. Methods A total of 148 allo-HSCT recipients were enrolled and divided into aGVHD group (n=85) and infection group (n=63). The age, onset time, pulmonary CT features and distribution patterns of lesions were compared between groups. Results The mean age and the mean onset time of aGVHD group were significant different with those of infection group (both P<0.05). The common manifestations of chest CT in aGVHD group included ground-glass opacity (GGO) (35/85, 41.18%), consolidation (14/85, 16.47%) and pleural effusion (12/85, 14.12%), which bilateral and diffuse distributed, with subpleural sparing. The common features of infection group included consolidation (33/63, 52.38%), GGO (32/63, 50.79%) and bronchial wall thickening (23/63, 36.51%), more unilateral and localized compared with those of aGVHD. The distribution patterns of lesions were statistically different between groups (all P<0.05). Thicken bronchial wall was more common in infection group than in aGVHD group (P<0.05). Conclusion CT manifestations of pulmonary aGVHD in children were characteristic, which were helpful to differentiation from infectious lesions combining with clinical information such as onset time.