【摘要】 目的探讨白血病异基因骨髓移植后晚期肺曲霉菌病的CT特征及其转归,以及外周血中性粒细胞计数对疾病诊断的价值。资料与方法对34例白血病异基因骨髓移植术后晚期肺部感染曲霉菌患者的胸部螺旋CT、高分辨率CT(HRCT)或亚高分辨CT进行观察及总结,并对病理、支气管镜分泌物培养为曲霉菌或血清半乳甘露聚糖检测(GM试验)阳性的患者行CT随访观察,同时记录这部分患者的外周血中性粒细胞计数,观察其与疾病的关系。结果白血病异基因骨髓移植后晚期肺曲霉菌感染胸部CT表现多样,最常见者为单发或多发结节;对于有病理、支气管镜检分泌物培养曲霉菌阳性或GM试验阳性的患者行CT随访观察,完全吸收者6例,好转者8例,略有好转者2例,无显著改变者2例,加重者2例。随访过程中有12例21次出现"气体新月征";晚期患者中性粒细胞计数平均为2.28×109/L[(0.94～3.19)×109/L]。结论白血病异基因骨髓移植后晚期肺曲霉菌病最常见的CT表现为单发或多发结节;气体新月征是疾病转归过程中的一种表现,必须结合既往CT的特征才能判断疾病的好转或恶化;此期中性粒细胞计数正常不能排除曲霉菌的诊断。更多还原

【Abstract】 Objective To discuss the CT characteristics and evolvement of pulmonary aspergillosis in leukaemia patients in advanced stage of allogeneic bone marrow transplantation(BMT),and the application worth of count of neutrophilic granulocyte in blood.Materials and Methods 34 leukaemia patients after BMT who toke pulmonary aspergillosis received chest CT and HRCT scan or volume CT.The images were observed and summarized by two doctors.The patients whose diagnosis was confirmed by pathology,bronchial secretion culture or serum galactomannan detection(GM test)positive were followed by CT,and the counts of neutrophilic granulocyte in blood were collected.Results In leukaemia patents after BMT,the most common chest CT sign of pulmonary aspergillosis is single or mutiple nodules,in the followed CT which came from the patients whose diagnosis was confirmed by pathology,bronchial secretion culture or GM test positive,the completely absorbed was six,improved was eight,improved appreciably was two,no improved was two,and the aggravated was two.Air-crescent sign was present in 21 followed CT images of 12 patients.The mean count of neutrophilic granulocyte in blood of these patients was 2.28×109/L(0.94-3.19×109/L).Conclusion Single or multiple nodules is the most common sign of the pulmonary aspergillosis in leukaemia patients after BMT.Air-crescent sign is just a sign of the pulmonary aspergillosis,which can’t be used to evaluate the prognosis of the disease alone.Normal account of neutrophilic granulocyte in blood can not exclude the diagnosis of pulmonary aspergillosis in leukaemia patients after BMT.更多还原