目的 分析血液病中性粒细胞缺乏状态下继发侵袭性肺曲霉菌病(IPA)的临床与初次CT表现,以提高其早期诊断准确率.方法 对南昌大学第一附属医院2015 年5月至2016年4月收治的21例中性粒细胞缺乏状态下继发IPA血液病患者的一般临床及初次CT表现进行回顾性分析.结果 21例患者早期CT表现为结节16例(76.2%)、晕征13例(61.2%)、实变8例(38.1%)、空气支气管征6例(28.6%)、胸膜下楔形实变影5例(23.8%)、胸腔积液5例(23.8%)、磨玻璃样影1例(4.8%)及树芽征1例(4.8%),未见空洞及"空气新月征"表现;临床表现以咳嗽、发热、喘息为主,G试验阳性率为28.6%(6/21),而GM试验均为阴性.结论 血液病患者中性粒细胞缺乏状态下继发IPA临床表现无特异性,G试验及GM试验阳性率较低,而早期观察CT上结节、晕征及楔形肺梗死灶等特征性影像表现对诊断有重要的参考价值,若在中性粒细胞缺乏当天送检血液GM试验的结果,可提高该病早期诊断准确率.%Objective To analyze the clinical and initial CT characteristics of secondary invasive pulmonary aspergillosis(IPA) in neutropenic patients,and to improve the early diagnostic accuracy of IPA.Methods Clinical and initial CT data of 21 neutropenic patients treated in the First Affiliated Hospital of Nanchang University between May 2015 and April 2016 for secondary IPA were analyzed retrospectively.Results Among the patients,CT showed nodules in 16(76.2%),halo sign in 13(61.2%),consolidation in 8(38.1%),air-filled bronchi in 6(28.6%),subpleural wedge-shaped consolidation in 5(23.8%),pleural effusion in 5(23.8%),ground-glass opacity in 1(4.8%),and tree-in-bud sign in 1(4.8%).No cavities or air-crescent sign were found in all patients.Clinical manifestations mainly included cough,fever and wheezing.The positive rate of G tests was 28.6%(6/21) and all GM tests were negative.Conclusion Neutropenic patients with secondary IPA have low positive rates of G and GM tests without specific clinical manifestations.However,early characteristic image manifestations such as nodules,halo sign and wedge-shaped pulmonary infarction lesions have important reference value in the diagnosis of IPA.Furthermore,the early diagnosis accuracy of IPA can be improved by the combination of CT findings and GM test results on the first day of neutropenia.
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