Yi H M, Xu C H, Yang D L, Lin Q S, Li Y, Sun H Y, Feng S Z
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2023 Feb 14;44(2):118-123. doi: 10.3760/cma.j.issn.0253-2727.2023.02.006.
To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients ((2)=11.039, =0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all >0.05) . The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.
总结血液系统疾病患者耶氏肺孢子菌肺炎的原始CT特征。对2014年1月至2021年12月在中国医学科学院血液病医院确诊为肺孢子菌肺炎（PJP）的46例患者进行回顾性分析。所有患者均进行了多次胸部CT及相关实验室检查，根据首次CT表现进行影像分型，并结合临床资料分析不同影像类型的特点。分析中，确诊发病机制的患者46例，男性33例，女性13例，中位年龄37.5（2 - 65）岁。11例患者经支气管肺泡灌洗（BALF）六胺银染色确诊，35例为临床诊断。在35例临床诊断患者中，16例通过肺泡灌洗宏基因组测序（BALF - mNGS）确诊，19例通过外周血宏基因组测序（PB - mNGS）确诊。首次胸部CT表现分为4种类型，包括磨玻璃（GGO）型25例（56.5%）、结节型10例（21.7%）、纤维化型4例（8.7%）、混合型5例（13.0%）。确诊患者、BALF - mNGS诊断患者和PB - mNGS诊断患者之间的CT类型无显著差异（(2)=11.039， =0.087）。确诊患者和PB - mNGS诊断患者的CT表现主要为GGO型（67.6%，73.7%），而BALF - mNGS诊断患者的CT表现主要为结节型（37.5%）。46例患者中，63.0%（29/46）外周血淋巴细胞减少，25.6%（10/39）血清G试验阳性，77.1%（27/35）血清乳酸脱氢酶（LDH）升高。不同CT类型在外周血淋巴细胞减少率、G试验阳性率和LDH升高率方面无显著差异（均>0.05）。血液系统疾病患者PJP的首次胸部CT表现以双肺多发GGO较为常见。结节型和纤维化型也是PJP的初始影像表现。
