CAJ | 학술논문

目的研究影响侵袭性肺曲霉病(IPA)患者的预后因素.方法回顾性分析四川大学华西医院在2005年1月至2011年6月间诊断的65例成人IPA患者的资料,并且诊断符合2008年欧洲癌症研究治疗组织/真菌病研究组(EORTC/MSG)的定义标准.胸部CT特征由两位从事胸部CT的高年资医生采用盲法解读患者的初次胸部CT表现,并对异常影像进行分类.根据IPA诊断后3个月病情转归将患者分为存活组(n=43)和病死组(n=22).采用成组t检验、x2检验或Fisher's精确检验行两组间变量的差异比较,多因素分析用Logistic回归方法.结果 65例患者中,确诊23例(35％),临床诊断42例(65％).单因素分析发现3个月存活组和病死组之间肺外感染、基础疾病控制差和机械通气方式差异具有统计学意义(均P ＜0.05),但所有CT特征(包括实变/块影、大结节、梗死状结节、晕轮征、磨玻璃征、小结节、中央低密度征、空洞、新月征、小气道表现、支气管扩张/壁增厚、胸腔积液和纵膈病变)以及侵袭方式的差异均无统计学意义(均P＞0.05).Logistic多因素回归分析发现仅基础疾病控制差影响3个月预后(P=0.001,OR=0.024,95％ CI:0.003 ～0.223,B=- 3.714,SE=1.129,Wald=10.821).结论基础疾病控制状况是判断IPA患者3个月生存的独立危险因素,但本研究中CT特征不提示预后.
목적 연구영향침습성폐곡매병(IPA)환자적예후인소.방법 회고성분석사천대학화서의원재2005년1월지2011년6월간진단적65례성인IPA환자적자료,병차진단부합2008년구주암증연구치료조직/진균병연구조(EORTC/MSG)적정의표준.흉부CT특정유량위종사흉부CT적고년자의생채용맹법해독환자적초차흉부CT표현,병대이상영상진행분류.근거IPA진단후3개월병정전귀장환자분위존활조(n=43)화병사조(n=22).채용성조t검험、x2검험혹Fisher's정학검험행량조간변량적차이비교,다인소분석용Logistic회귀방법.결과 65례환자중,학진23례(35％),림상진단42례(65％).단인소분석발현3개월존활조화병사조지간폐외감염、기출질병공제차화궤계통기방식차이구유통계학의의(균P ＜0.05),단소유CT특정(포괄실변/괴영、대결절、경사상결절、훈륜정、마파리정、소결절、중앙저밀도정、공동、신월정、소기도표현、지기관확장/벽증후、흉강적액화종격병변)이급침습방식적차이균무통계학의의(균P＞0.05).Logistic다인소회귀분석발현부기출질병공제차영향3개월예후(P=0.001,OR=0.024,95％ CI:0.003 ～0.223,B=- 3.714,SE=1.129,Wald=10.821).결론 기출질병공제상황시판단IPA환자3개월생존적독립위험인소,단본연구중CT특정불제시예후.
Objective To investigate the factors implicated in the outcomes of patients with invasive pulmonary aspergillosis (IPA).Methods During a 5-year period,65 patients with IPA met the criteria set by the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG)in 2008 were retrospectively evaluated. The initial CT findings of eligible patients were reviewed by two senior radiologists who specialized in chest radiology.Patients were divided into the survivor (n =43 ) and non-survivor (n =22) groups according to their survival as long as 3 months after the diagnosis of IPA was made.An initial univariate analysis was used to screen variables that were related to prognosis,followed by a multivariate logistic regression analysis to examine these variables. Results Of the 65 IPA patients analyzed,23 (35％) had a proven diagnosis and 42 (65％) were probable ones.The univariate analysis showed that the rates of extra-pulmonary infection,uncontrolled underlying diseases and invasive mechanical ventilation were significantly different between the 3-month survival group and the non-survival group ( P ＜0.05,respectively),whereas chest CT findings,including air-space consolidation/massive consolidation,macronodules,infarct-like macronodules,halo signs, ground-glass opacities,small nodules,hypodense signs,cavities,crescent signs,small-airway findings,bronchial wall thickening/bronchiectasis,pleural effusion and hydro-pericardium, were not significantly different between the two groups (P ＞ O.05,respectively).Logistic regression analysis revealed that an uncontrolled underlying disease was the only independent predictor of 3-month mortality in patients with IPA (P =0.001,OR:O.024,95 ％ CI:O.003 ～0.223,B =- 3.714,SE =1.129,Wald =10.821 ). Conclusions An uncontrolled co-morbidity was the only independent predictor of mortality within 3 months in patients with IPA.The initial CT findings did not confer any informatioin of implication in predicting the outcomes of IPA patients.