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目的研究慢性重型肝炎并发侵袭性肺部真菌感染患者的CT特点,为合理选用抗菌药物预防控制并发感染提供依据。方法选取2010年3月-2013年12月进行治疗的慢性重型肝炎并发侵袭性肺真菌感染的94例患者为研究对象,随机分为两组,各47例;对照组患者采用常规治疗措施,试验组患者采用氟康唑治疗,根据CT检查结果,回顾性分析两组患者的病变和病原菌分布。结果治疗前,对照组真菌培养结果显示假丝酵母菌属占44.58%、曲霉菌属占27.71%、组织胞浆菌占21.69%、其他真菌占6.02%,试验组假丝酵母菌属占43.96%、曲霉菌属占42.86%、组织胞浆菌占15.38%、其他真菌占4.40%,两组患者治疗前的病原菌分布状况基本相同,经比较差异无统计学意义;治疗前,对照组患者CT结果表现为结节占40.42%、磨玻璃影占27.66%、网格或线样占21.28%、胸腔积液占10.64%;试验组CT结果中总显效率结节占36.17%、磨玻璃影占31.92%、网格或线样占25.53%、胸腔积液占6.38%。结论慢性重型肝炎并发侵袭性肺真菌感染患者多以假丝酵母菌属和曲霉菌属较为常见;合理使用氟康唑治疗慢性重型肝炎并发侵袭性肺真菌感染疗效确切;患者CT主要表现为结节和磨玻璃影,但无特异性,需结合临床资料做出准确判断。
Objective To study the CT features of patients with chronic severe hepatitis complicated by invasive pulmonary fungal infection and provide evidence for rational use of antimicrobial agents in the prevention and control of concurrent infections. Methods Ninety-four patients with chronic severe hepatitis complicated with invasive pulmonary fungal infection who were treated from March 2010 to December 2013 were randomly divided into two groups (n = 47 in each group). Patients in the control group were treated with routine treatment, The patients were treated with fluconazole. According to the results of CT examination, the pathological changes and pathogenic bacteria distribution of the two groups were retrospectively analyzed. Results Before treatment, the results of fungal culture in the control group showed that Candida species accounted for 44.58%, Aspergillus species accounted for 27.71%, Histoplasmosis species accounted for 21.69%, other fungi accounted for 6.02%, Candida genus accounted for 43.96% , Aspergillus accounted for 42.86%, histoplasmosis accounted for 15.38%, other fungi accounted for 4.40%, the distribution of the two groups of patients before treatment are basically the same, the difference was not statistically significant; before treatment, the control group of patients with CT results The results of nodules accounted for 40.42%, ground glass accounted for 27.66%, grid or line type accounted for 21.28%, pleural effusion accounted for 10.64%; test group CT results in the total efficiency of nodules 36.17%, ground glass accounted for 31.92 %, 25.53% of the grid or line samples, pleural effusion accounted for 6.38%. Conclusion Most patients with chronic severe hepatitis complicated with invasive pulmonary fungal infection are Candida spp. And Aspergillus spp. More commonly. Fluconazole is effective in treating chronic severe hepatitis complicated with invasive pulmonary fungal infection. CT is mainly characterized by nodules And ground glass shadow, but no specificity, need to make accurate judgments based on clinical data.