CAJ | 학술논문

背景：实体器官移植后肺部感染的发病率和死亡率居高不下，尤其是作为机会感染的曲菌，早期诊断侵袭性肺曲霉菌病是困难的。目的：总结实体器官移植后侵袭性曲菌性肺炎的CT表现。方法：以“实体器官移植/肾移植/肝移植/肺移植/心脏移植，曲菌，真菌，霉菌，肺，侵袭性，体层摄影术，X线计算机”为中文捡索词，以“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis ， fungus ， mold ， pulmonary invasive, tomography computerized”为英文检索词，检索维普和中国知网(CNKI)期刊全文数据库、Medline，highwire和外文生物医学期刊全文数据库(Foreign Journals Integration System)2001年1月至2012年10月有关肺曲菌感染和真菌或霉菌肺感染报告中主要涉及曲菌的侵袭性曲菌肺炎 CT 表现的临床报道。然后二次人工检索实体器官移植后，纳入有关实体器官移植后侵袭性曲菌肺炎CT表现的文献，排除重复性研究和不典型报道。结果与结论：实体器官移植后侵袭性肺曲霉菌病典型的胸部 CT 表现包括结节、肿块、实变以及磨玻璃影。随感染时间依次出现晕征、反晕征、空洞和空气半月征。这些征象的发生率的不同可能与 CT 检查时间和早期抗真菌治疗已经真菌预防性治疗有关。有意义的结果是侵袭性肺曲霉菌病征象与患者预后的关系。无实变或肿块和小腔空洞存在可能与更好预后相关。大结节、多发梗死性实变、肾脏替代治疗和持久性的血清半乳甘露聚糖阳性是90 d的死亡率独立的预测因子。而代表出血的晕征与90 d的死亡率无关。尽管报告较少，用 CT 肺血管造影诊断侵袭性真菌性肺炎是有前景的诊断手段，可以早期发现反映侵袭性血管受累的血管闭塞征，其敏感性和特异性优于晕征，与血清曲菌半乳甘露聚糖试验近似。揹景：實體器官移植後肺部感染的髮病率和死亡率居高不下，尤其是作為機會感染的麯菌，早期診斷侵襲性肺麯黴菌病是睏難的。目的：總結實體器官移植後侵襲性麯菌性肺炎的CT錶現。方法：以“實體器官移植/腎移植/肝移植/肺移植/心髒移植，麯菌，真菌，黴菌，肺，侵襲性，體層攝影術，X線計算機”為中文撿索詞，以“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis ， fungus ， mold ， pulmonary invasive, tomography computerized”為英文檢索詞，檢索維普和中國知網(CNKI)期刊全文數據庫、Medline，highwire和外文生物醫學期刊全文數據庫(Foreign Journals Integration System)2001年1月至2012年10月有關肺麯菌感染和真菌或黴菌肺感染報告中主要涉及麯菌的侵襲性麯菌肺炎 CT 錶現的臨床報道。然後二次人工檢索實體器官移植後，納入有關實體器官移植後侵襲性麯菌肺炎CT錶現的文獻，排除重複性研究和不典型報道。結果與結論：實體器官移植後侵襲性肺麯黴菌病典型的胸部 CT 錶現包括結節、腫塊、實變以及磨玻璃影。隨感染時間依次齣現暈徵、反暈徵、空洞和空氣半月徵。這些徵象的髮生率的不同可能與 CT 檢查時間和早期抗真菌治療已經真菌預防性治療有關。有意義的結果是侵襲性肺麯黴菌病徵象與患者預後的關繫。無實變或腫塊和小腔空洞存在可能與更好預後相關。大結節、多髮梗死性實變、腎髒替代治療和持久性的血清半乳甘露聚糖暘性是90 d的死亡率獨立的預測因子。而代錶齣血的暈徵與90 d的死亡率無關。儘管報告較少，用 CT 肺血管造影診斷侵襲性真菌性肺炎是有前景的診斷手段，可以早期髮現反映侵襲性血管受纍的血管閉塞徵，其敏感性和特異性優于暈徵，與血清麯菌半乳甘露聚糖試驗近似。
배경：실체기관이식후폐부감염적발병솔화사망솔거고불하，우기시작위궤회감염적곡균，조기진단침습성폐곡매균병시곤난적。목적：총결실체기관이식후침습성곡균성폐염적CT표현。방법：이“실체기관이식/신이식/간이식/폐이식/심장이식，곡균，진균，매균，폐，침습성，체층섭영술，X선계산궤”위중문검색사，이“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis ， fungus ， mold ， pulmonary invasive, tomography computerized”위영문검색사，검색유보화중국지망(CNKI)기간전문수거고、Medline，highwire화외문생물의학기간전문수거고(Foreign Journals Integration System)2001년1월지2012년10월유관폐곡균감염화진균혹매균폐감염보고중주요섭급곡균적침습성곡균폐염 CT 표현적림상보도。연후이차인공검색실체기관이식후，납입유관실체기관이식후침습성곡균폐염CT표현적문헌，배제중복성연구화불전형보도。결과여결론：실체기관이식후침습성폐곡매균병전형적흉부 CT 표현포괄결절、종괴、실변이급마파리영。수감염시간의차출현훈정、반훈정、공동화공기반월정。저사정상적발생솔적불동가능여 CT 검사시간화조기항진균치료이경진균예방성치료유관。유의의적결과시침습성폐곡매균병정상여환자예후적관계。무실변혹종괴화소강공동존재가능여경호예후상관。대결절、다발경사성실변、신장체대치료화지구성적혈청반유감로취당양성시90 d적사망솔독립적예측인자。이대표출혈적훈정여90 d적사망솔무관。진관보고교소，용 CT 폐혈관조영진단침습성진균성폐염시유전경적진단수단，가이조기발현반영침습성혈관수루적혈관폐새정，기민감성화특이성우우훈정，여혈청곡균반유감로취당시험근사。
BACKGROUND:The morbidity and mortality of lung infection after solid organ transplantation remains high, especial y the opportunistic aspergil osis infection. The early diagnosis of invasive pulmonary aspergil osis is difficult. OBJECTIVE:To summarize the CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation. METHODS:The VIP database, CNKI database, Medline database, Highwire database and Foreign Journals Integration System were retrieved with the key words of“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis, fungus, mold, pulmonary invasive, tomography computerized”in Chinese and English for the articles published from January 2001 to October 2012. The clinical reports related with the CT manifestations of invasive pulmonary aspergil osis among the reports of pulmonary aspergil osis infections and the fungus or mold lung infections were selected. Secondary manual retrieval of solid organ transplantation was performed, and the literatures on the CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation were included. Reproductive research and atypical report were excluded. RESULTS AND CONCLUSlON:The typical chest CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation included nodules, masses, consolidations and ground-glass opacities. With infection time prolonged, the halo sign, reversed halo sign, cavitis and air crescent sign appeared successively. Different incidences of these signs may be associated with the time interval between onset to a CT examination, fungus preventive treatment time and early antifungal treatment. Meaningful results are the relationship between invasive pulmonary aspergil osis signs and the prognosis of patients. No consolidations or masses and presence of smal cavitis may be related with a better prognosis. Greater nodules, multi-infarct consolidation, renal replacement therapy and persistent positive serum galactomannan is a 90-day independent predictor for mortality. Halo sign on behalf of bleeding has nothing to do with the 90-day mortality. Although the report is less, the CT pulmonary angiography is a promising diagnostic tool for the diagnosis of invasive fungal pneumonia, which can early detect the vascular occlusion used to reflect the invasive vascular involvement, and its sensitivity and specificity are better than the halo sign, and approximate to serum galactomannan test.