CAJ | 학술논문

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C T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C T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。
목적：연구만성중형간염병발침습성폐부진균감염환자적CT 특점，위합리선용항균약물예방공제병발감염제공의거。방법선취2010년3월－2013년12월진행치료적만성중형간염병발침습성폐진균감염적94례환자위연구대상，수궤분위량조，각47례；대조조환자채용상규치료조시，시험조환자채용불강서치료，근거CT검사결과，회고성분석량조환자적병변화병원균분포。결과치료전，대조조진균배양결과현시가사효모균속점44．58％、곡매균속점27．71％、조직포장균점21．69％、기타진균점6．02％，시험조가사효모균속점43．96％、곡매균속점42．86％、조직포장균점15．38％、기타진균점4．40％，량조환자치료전적병원균분포상황기본상동，경비교차이무통계학의의；치료전，대조조환자C T결과표현위결절점40．42％、마파리영점27．66％、망격혹선양점21．28％、흉강적액점10．64％；시험조C T결과중총현효솔결절점36．17％、마파리영점31．92％、망격혹선양점25．53％、흉강적액점6．38％。결론만성중형간염병발침습성폐진균감염환자다이가사효모균속화곡매균속교위상견；합리사용불강서치료만성중형간염병발침습성폐진균감염료효학절；환자CT주요표현위결절화마파리영，단무특이성，수결합림상자료주출준학판단。
OBJECTIVE To study CT image features of patients with chronic severe hepatitis combined with invasive pulmonary fungal infections ,so as to provide the basis for rational use of antibiotics for complicated infections . METHODS From Mar .2010 to Dec .2013 ,a total of 94 cases of patients with chronic severe hepatitis complicated with invasive pulmonary fungal infections were chosen as study objects .They were randomly divided into two groups with 47 cases each .The control group was treated normally while the experiment group was adopted flu‐conazole .The retrospective analysis of the pathological changes and distribution of pathogenic bacteria was con‐ducted in the two groups according to the CT results .RESULTS Before the treatment ,the control group showed Saccharomycetes (44 .58% ) ,Aspergillus (27 .71% ) ,Histoplasmosis (21 .69% ) ,and other bacteria (6 .02% ) in the culture dish .And the experiment group had Saccharomyces (43 .96% ) ,Aspergillus (42 .86% ) ,Histoplas‐mosis (15 .38% ) ,and other bacteria (4 .40% ) .The pathogens distributions of two groups of patients before the treatment were basically the same ,and the difference was not significant .Before the treatment ,the CT results of the control group showed 40 .42% of the nodules ,27 .66% of the ground glass shadow ,21 .28% of grid or wire‐like ,and 10 .64% of pleural effusion .And in the experimental group ,the CT results showed 36 .17% of nodules , 31 .92% of the ground glass shadow ,25 .53% of grid or wire‐like ,and 6 .38% of pleural effusion .CONCLUSION Candida mycoderma and Aspergillus are the common bacteria infected by patients with chronic severe hepatitis combined with invasive pulmonary fungal infections .Rational use of fluconazole can be effective to these patients ;and CT images mainly manifest as nodules and ground glass shadow without specificity .Accurate diagnosis should be made with reference to clinical data .