Comparison of Clinical and CT Findings of Invasive Aspergillus and Candida Albicans Infections in the Lung
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目的 比较肺部侵袭性曲霉菌与白色念珠菌感染的CT表现,以期有助于二者的临床诊断与鉴别.方法 回顾性分析209 例肺部侵袭性真菌感染患者的临床和影像资料,依据真菌类型分为曲霉菌组和白色念珠菌组,观察记录其CT表现.依据影像学表现,将CT表现分为A型(实变为主型)、B型(磨玻璃影为主型)、C型(结节或肿块为主型)、D型(空洞为主型).运用人工智能定量分析比较患者肺部病变累及程度和范围.依据病灶占比,将肺部受累程度分为轻度(<20%)、中度(20%～40%)和重度(>40%).结果 肺部曲霉菌感染与白色念珠菌感染多发于中老年男性和免疫功能低下者.两者主要CT表现以累及双肺的实变为主型病变最为常见,其他CT征象以胸膜增厚(58.6%vs 59.0%)最为多见,胸腔积液(31.0%vs 57.4%)次之.曲霉菌组胸腔积液发生率低于白色念珠菌组(P<0.001).曲霉菌组右肺中叶[27.7(3.1,90.5)cm3 vs 9.2(0.9,26.1)cm3,P = 0.005]、左肺上叶[74.0(2.1,250.9)cm3 vs 16.7(2.9,57.3)cm3,P = 0.006]和左肺下叶[100.1(21.5,245.9)cm3 vs 56.8(10.2,110.1)cm3,P = 0.010]处的病灶体积显著大于白色念珠菌组.在肺部受累程度上,两者均以轻度为主(73.1%vs 88.0%),但曲霉菌组中度(19.4%vs 9.4%)和重度(7.5%vs 2.6%)发生率显著高于白色念珠菌组(P = 0.038).结论 肺部侵袭性曲霉菌与白色念珠菌感染的CT表现具有差异,CT扫描有助于明确诊断和进行临床诊治.
Objective To observe and compare the CT findings of pulmonary invasive aspergillus and Candida albicans infection in order to contribute to the clinical diagnosis and differentiation of pulmonary fungal infection.Methods The clinical and imaging data of 209 patients with pulmonary fungal infection were analyzed retrospectively.According to the type of fungi,they were divided into Aspergillus group and Candida albicans group,and their CT signs were observed and re-corded.According to the imaging findings,CT images were divided into type A(mainly consolidation type),type B(mainly ground glass density shadow type),type C(mainly nodules or masses type)and type D(mainly cavity type).Artificial in-telligence(AI)was used to quantitatively analyze and compare the extent and scope of pulmonary lesions.According to the proportion of lesions,the degree of bilateral lung involvement is divided into mild(<20%),moderate(20%-40%)and severe(>40%).Results Pulmonary Aspergillus infection and Candida albicans infection were more common in mid-dle-aged and elderly men and immunocompromised patients,and the main CT findings of both were consolidation lesions in-volving both lungs.Other CT findings in both groups were most common with pleural thickening(58.6%vs 59.0%),fol-lowed by pleural effusion(31.0%vs 57.4%).The incidence of Pleural effusion in Aspergillus group was significantly low-er than that in Candida albicans group(P<0.001).The lesion volumes at the middle lobe of the right lung[27.7(3.1,90.5)cm3 vs 9.2(0.9,26.1)cm3,P = 0.005],upper lobe of the left lung[74.0(2.1,250.9)cm3 vs 16.7(2.9,57.3)cm3,P = 0.006]and lower lobe of the left lung[100.1(21.5,245.9)cm3 vs 56.8(10.2,110.1)cm3,P = 0.010]were significantly larger in the Aspergillus group than in the Candida albicans group.In terms of the degree of bilateral lung in-volvement,both were mainly mild(73.1%vs 88.0%),but the incidence of moderate(19.4%vs 9.4%)and severe(7.5%vs 2.6%)in Aspergillus group was significantly higher than that in Candida albicans group(P = 0.038).Con-clusion The CT signs of pulmonary invasive aspergillus and Candida albicans infection are divergent.CT scan is helpful for definite diagnosis and clinical treatment.
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