慢性重型乙型肝炎患者合并侵袭性肺真菌感染的CT特征

目的:探讨慢性重型乙型肝炎(CSHB)患者并发侵袭性真菌感染(IPFI)的特征性CT表现。方法:回顾性分析40例经组织学或细菌学证实的CSHB并发IPFI患者的CT表现,观察病变的形态、范围、边界、密度和病灶大小特点,并分析其与病原菌的关系。结果:40例CSHB患者并发侵袭性真菌感染中念珠菌20例,曲霉菌15例,组织胞浆菌3例,肺孢子菌2例。CT征象中出现最多的为结节(18例,45%),其他依次为实变(10例,27.1%)、网格或线样影(5例,13.5%)、磨玻璃影(4例,10.8%)、胸腔积液(3例,8.1%)。CT征象在各病原体感染中出现频率差异均无统计学意义(P值均>0.05)。结论:CSHB患者并发IPFI的CT表现缺乏特异性,需结合临床实验室资料、病变分布及病变演变才能作出明确诊断。

Aanalysis of CT findings of invasive pulmonary fungal infections in patients with chronic severe hepatitis

Objective：To review the CT findings in severe hepatitis patients with invasive pulmonary fungal infections（IPFI）.Methods：The medical records were reviewed in 40 chronic severe hepatitis patients with IPFI,who had undergone pulmonary thin section CT in this study.The lesion form,extent,margin,density and size of IPFI were analyzed in correlation with the final diagnosis retrospectively.And the relationship with the causative factor of mycosis was also assessed.Results：Pathogens：Candida albicans（n=20） was the most common,followed by aspergillus（n=15） and histoplasmosis（n=3）,pneumocystis（n=2）.CT findings：nodules（18,45%） were the most common findings of chronic severe hepatitis patients with IPFI,followed by consolidations（10,27.1%）,reticular or linear opacities（5,13.5%）,Ground-glass attenuations（4,10.8%） and pleural effusion（3,8.1%）.There were no statistically significant difierences in the prevalence of CT patterns（P〉0.05）.Conclusions：The CT findings in chronic severe hepatitis patients with IPFI are too complex to be easily distinguished from other diseases.Definite diagnosis can only be made by combining clinical laboratory data,lesion distribution and disease evolution.