【摘要】 目的探讨肺部CT在儿童侵袭性肺真菌病早期诊断中的作用和价值。方法回顾性收集同济医院儿科呼吸病房自2015年1月至2017年6月诊断的侵袭性肺真菌病156例,对其肺部CT特征、G试验、GM试验及痰涂片、痰培养结果进行分析和总结,并依据病原学证据分为病原学阴性组和病原学阳性组,比较两组患儿肺部CT特征。结果 156例诊断为侵袭性肺真菌病患儿中,肺部CT表现为真菌感染特征而微生物学证据阴性者75例,占48.08%。微生物学证据存在一项或多项阳性者81例,占51.92%。大多数患儿肺部CT表现以斑片、结节及胸膜增厚等多种征象并存为主,极少仅有单一表现。肺部CT特征性表现由多到少依次为多发斑片影(64.74%)、单侧或双侧胸膜粘连增厚(27.56%)、单发或多发结节及团块影(21.15%)、条片影(16.67%)、磨玻璃样(14.10%)、肺实变(10.90%),肺不张和胸腔积液少见,分别占3.85%和2.56%。病原阳性组和病原阴性组患儿肺部CT特征比较显示多发斑片影、结节及团块影以及肺实变胸膜增厚粘连等特征性改变的发生率在两组间差异均无统计学意义(均P>0.05)。结论儿童侵袭性肺真菌病肺部CT影像学特征典型,检查方便快捷,可早于病原学为临床诊断提供依据,并可提早显示病灶和病变范围,是早期诊断肺真菌病的有力手段。更多还原

【Abstract】 Objective To investigate value of pulmonary CT in the early diagnosis of invasive pulmonary fungal disease in children.Methods Totally,156 cases of invasive pulmonary fungal disease diagnosed in our pediatric ward from January 2015 to June 2017 were retrospectively analyzed.The CT imaging characteristics,G test,GM test and sputum smear and sputum culture were harvested and analyzed.All the cases were divided into pathogen negative group and pathogen positive group,and pulmonary CT characteristics between the two groups were compared.Results In total,156 children diagnosed with invasive pulmonary fungal disease were enrolled,75 cases(48.08%)were in pathogen negative group and 81 cases(51.92%)were in pathogen positive group.Most of the cases had multiple signs of CT features,fewer cases had only single sign.Lung CT imaging characteristics were multiple speckle shadows(64.74%),unilateral or bilateral pleural adhesion thickening(27.56%),single or multiple nodules and lumps(21.15%),strip shadow(16.67%),ground glass(14.10%),pulmonary consolidation(10.90%);atelectasis and pleural effusion were rare,accounting for 3.85% and 2.56% respectively.There was no significant difference between the two groups in the incidence of specific changes in plaque shadow,nodule and lumps,and pulmonary consolidation pleural thickening adhesions in the lung CT imaging, between the pathogen positive group and the pathogen negative group(P>0.05).Conclusion Features of CT images of children with invasive pulmonary fungal disease are typical.The method is convenient and rapid,can provide the basis for clinical diagnosis earlier than pathogen,and can show the lesion and lesion range earlier.It is effective for diagnosing pulmonary fungal disease.更多还原