【文章內(nèi)容簡介】 1CHEST February 2023 vol. 129 no. 2 333340 Immunopromised patients often undergo an evolution to cavitary lesions that represent a more aggressive disease nature. 肺炎和持續(xù)高熱是 IPA主要臨床體征Ge Maschmeyer,1Antje Haas, Oliver A. Cornely. Invasive Aspergillosis: Epidemiology, Diagnosis and Management in Immunopromised Patients. Drugs 2023。 67 (11): 5671601CT影像學檢查有助于 IPA的診斷0102030405060708090100≥1個大結節(jié) 暈輪征 實變 梗死形狀的結節(jié)空洞 空氣半月征組織病理學支持暈輪征是曲霉菌病的表現(xiàn)但是其他病原體感染也可引起暈輪征有暈輪征的患者治療反應好(成功率為 52% ，而沒有者成功率為 29%) 1. Greene RE, Schlamm HT, Oestmann al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin. Infect Dis. 2023 44: 37392. Caillot D, Couaillier JF, Bernard al. Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic puted tomography scans in patients with neutropenia J Clin Oncol. 2023 Jan 1。19(1):253994%61%30% 27%20%10%早期 CT檢查有助于提供 IPA治療滿意率R. E. Greene, H. T. Schlamm, P. Stark, et al. Radiologic findings in acute invasive pulmonary aspergillosis: Utility and reliability of halo sign and aircrescent sign for diagnosis and treatment of IPA in highrisk patients. Presented at 13th ECCMID,1013 May 2023, Glasgow, UK肺曲菌病暈輪征 Halo sign肺曲菌病 新月征 (aircrescent sign)確診和臨床診斷病人暈輪征分類 病人總數(shù) CT檢查例數(shù) 陽性例數(shù) 陽性率血液腫瘤病人 38 35 28 80% 其他病人 67 17 3 17%83例非血液病患者 IPA的 CT表現(xiàn)影像學改變 例數(shù)（ %）正常 0彌漫性網(wǎng)狀小結節(jié)影 12（ 14%）非特異滲出和實變 42（ 50%）結節(jié)樣改變 25（ 30%）新月征 1（ 1%）暈論征 2（ 2%）空洞形成 1（ 1%）Crit Care. 2023。 10(1): R31 COPD合并 IPA影像及纖支鏡下表現(xiàn)（ 54歲，男性 Ⅳ 期COPD合并 IPA影像學（ 69歲，男性， Ⅳ 期）COPD合并 IPA79歲， Ⅳ診斷構成要素三早期提示高?；颊甙l(fā)生侵襲性真菌感染微生物學172例下呼吸道真菌培養(yǎng)陽性ICU患者的最后診斷Crit Care 2023。10:R32呼吸道分泌物檢測結果有助于 IFI早期診斷Perfect JR, Cox GM, Lee JY,.et al. The impact of culture isolation of Aspergillus species: a hospitalbased survey of aspergillosis. Clin Infectious 。33:18241833GM檢測有助于 IA快速診斷Kawazu M, et al. Prospective parison of the diagnostic potential of realtime PCR, doublesandwich enzymelinked immunosorbent assay for galactomannan, and a (13)βDglucan test in weekly screening for invasive aspergillosis in patients with hematological disorders. J Clin Microbiol 2023。 42:27332741.ICU確診和臨床診斷 IA病人 GM結果分類 病人總數(shù) GM測定例數(shù) 陽性例數(shù) 陽性率血液腫瘤病人 38 35 28 80% 其他病人 67 51 27 53%BAL及血清 GM結果比較BALF 血清American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 2734, (2023)肺泡灌洗液 GM優(yōu)于血清 GM患者數(shù)（ 198人）敏感性（ %）特異性（%）PPV（ %）NPV（ %）血清 47 93 73 82BAL 85 100 100 88Becker .,Lugtenburg .,Cornelissen .,et al. Galactomannan detection in puterized tomographybased bronchoalveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis. 2023. ,121,72例病理診斷患者 GM和培養(yǎng)的比較項目 IA（ 26例） nonIA（ 46例）總計（ 72例）血清 GM陽性 11(42%) 3(6%) 14陰性 15(58% 43(94%) 58BALGM陽性 23(88%) 6(13%) 2