摘要
目的:分析血液病合并毛霉菌病临床诊治特点,供临床参考。方法:纳入2018年10月至2023年12月我院经临床综合诊断为血液病合并毛霉菌病的连续病例65例。所有患者均接受胸部CT检查,其中14例行头颅MRI检查。8例接受肺组织活检,57例行血、肺泡灌洗液或组织宏基因二代测序,分析其CT表现及总结诊断过程。结果:肺毛霉菌占我院同期确诊真菌感染的5.30%(65/1233例)。本组58例为肺毛霉菌病,7例为累及多器官的播散性毛霉菌病。肺毛霉菌病患者CT表现为单发肺内斑片状实变(23/65)、混合型(11/65)、多发结节(28/65)或弥漫渗出(3/65),伴有反晕征29例、晕征25例、胸腔积液20例、结节数目大于10个者11例,2例患者CT增强检查显示血管截断征。播散性毛霉菌病患者表现为肺内多发结节7例,同时伴脑内单发或多发结节6例、脑内弥漫性梗死灶1例、脾内和肾内结节2例。首次胸部CT到临床确诊平均时间(4.3±1.8)d,CT怀疑真菌感染后进行,血或组织、肺泡二代测序检查,经两性霉素B等抗真菌治疗后好转58例,手术切除肺组织2例,家属放弃治疗失访2例,死亡3例。结论:肺毛霉菌约占血液病住院患者合并真菌感染的5%;肺部CT影像主要表现为单发大片突出和多发结节。近45%患者CT影像出现反晕征,38.5%的患者晕征,可为诊断提供提示性参考,二代测序在临床诊断中发挥重要作用。
Objective This study aims to analyze the clinical diagnosis and treatment characteristics of hematologic diseases combined with mucormycosis for clinical reference.Methods A total of 65 consecutive cases of hematologic diseases combined with mucormycosis,clinically diagnosed at our hospital from October 2018 to December 2023,were included.All patients underwent chest CT examination,and 14 of them underwent cranial MRI examination.Eight patients underwent lung tissue biopsy,and 57 underwent blood,alveolar lavage fluid,or tissue metagenomic next-generation sequencing.The CT findings were analyzed and the diagnostic process was summarized.Results Pulmonary mucormycosis accounted for 5.30%(65/1 233 cases) of all fungal infections diagnosed in our hospital during the same period.Among these patients,58 had pulmonary mucormycosis,and 7 had disseminated mucormycosis involving multiple organs.Chest CT of patients with pulmonary mucormycosis showed single patchy consolidation(23/65),multiple nodules(28/65),mixed nodules(11/65),or diffuse exudation(3/65) in the lungs,with 29 cases showing reverse halo sign,25 cases showing halo sign,20 cases with pleural effusion,11 cases with more than 10 nodules,and 2 cases with vessel truncation sign on enhanced CT examination.In patients with disseminated mucormycosis,there were 7 cases of multiple nodules in the lung,6cases of single or multiple nodules in the brain,1 case of diffuse infarction in the brain,and 2 cases of nodules in the spleen and kidney.The average time from the first chest CT to clinical diagnosis was(4.3±1.8) days.After CT suspected fungal infection,blood or tissue and alveolar second-generation sequencing were performed.After antifungal treatment,such as amphotericin B,58 patients improved,2 patients underwent surgical resection of lung tissue,2 patients were lost to follow-up after their families decided to stop treatment,and 3 patients died.Conclusions Pulmonary mucormycosis accounts for about 5% of fungal infections in hospitalized patients with hematological diseases.Chest CT mainly shows single large consolidation and multiple nodules,with 45% showing reverse halo sign and 38.5% showing halo sign.These signs can provide reference for diagnosis,and second-generation sequencing plays an important role in clinical diagnosis.
作者
李英
蒋晗
王晓雪
魏浩楠
LI Ying;JIANG Han;WANG Xiaoxue;WEI Haonan(Department of radiology,State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medi-cal Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China)
出处
《诊断学理论与实践》
2024年第5期494-499,共6页
Journal of Diagnostics Concepts & Practice
关键词
血液病
毛霉菌病
计算机体层成像
Hematologic diseases
Mucormycosis
Computed tomography
