三种常见肺部真菌感染CT表现的比较研究

摘要

目的:探讨肺隐球菌病、侵袭性肺曲霉病(IPA)、肺念珠菌病CT表现的差异,为其鉴别诊断提供依据.方法:回顾性分析43例肺隐球菌病、35例侵袭性肺曲霉病、22例肺念珠菌病的CT表现,并对其CT征象进行统计学分析.结果:肺隐球菌病以单纯性结节或肿块影(79.1％)为主要CT表现,而IPA及肺念珠菌病均以混合性病变(57.1％及63.6％)为主要表现,两者实变的发生率均显著高于肺隐球菌病(P值均＜0.05).肺隐球菌病结节以多发聚集型出现的概率显著高于IPA(P=0.004),IPA及肺念珠菌病结节以多发散在型出现的概率均显著高于肺隐球菌病(P值均＜0.05)；肺隐球菌病结节中支气管充气征的发生率显著高于肺念珠菌病(P=0.011),IPA结节中空洞的发生率显著高于肺念珠菌病(P=0.008)；IPA的实变以胸膜为基底分布的概率显著高于肺隐球菌病(P=0.001)；肺隐球菌病的实变于支气管周围分布且出现支气管充气征的概率显著高于IPA(P＜0.05).结论:肺隐球菌病、侵袭性肺曲霉病、肺念珠菌病的部分CT征象存在显著差异,可为鉴别诊断提供依据.%Objective:To investigate the difference of CT features in pulmonary cryptococcosis and invasive pulmonary aspergillosis (IPA) as well as pulmonary candidiasis,and to provide the basis for differential diagnosis.Methods1:CT findings of 43 cases with pulmonary cryptococcosis,35 cases with IPA and 22 cases with pulmonary candidiasis were retrospectively reviewed.Different patterns of CT scan abnormalities between them were compared by x2 or Fisher's exact test.Results:The most common CT findings of pulmonary cryptococcosis were solitary or multiple nodules or masses (79.1％),while findings of IPA and pulmonary candidiasis were mixed patterns (57.1％ and 63.6 ％ respectively).Airspace consolidation was more frequently present in IPA and pulmonary candidiasis than that in pulmonary cryptococcosis respectively (P＜0.05).Nodules/masses were more frequently present in multiple clustered pattern in pulmonary cryptococcosis than those in IPA (P=0.004).Nodules/masses were more frequently present in multiple scattered pattern in IPA and in pulmonary candidiasis than those in pulmonary cryptococcosis respectively (P＜0.05).The incidence of air bronchogram within nodules in pulmonary cryptococcosis was significantly higher than that in pulmonary candidiasis (P=0.011).The incidence of cavity within nodules in IPA was significantly higher than that in pulmonary eandidiasis (P=0.008).Airspace consolidation was more frequently present in pleural-based pattern in IPA than that in pulmonary cryptococcosis (P=0.001).Airspace consolidation was more frequently present in peribroncovascular region and with air bronchogram in pulmonary cryptococcosis than that in IPA (P＜0.05).Conclusion:CT findings in pulmonary cryptococcosis and invasive pulmonary aspergillosis (IPA) as well as pulmonary candidiasis had statistical differences,which are helpful to the differential diagnosis of these diseases.