论文部分内容阅读
目的探讨急性白血病患者化疗期间出现发热并伴有肺部非特异影像学改变的临床特征、影像学表现及治疗方法。方法回顾性分析2014年12月-2016年1月合并发热及肺部非特异影像学改变、并治疗有效29例急性白血病患者的特点及转归。结果 29例患者中,19例治愈,总治愈率65.5%;仅表现为单纯双肺弥漫/多发磨玻璃影的11例患者中,10例治愈,治愈率90.9%;磨玻璃影基础上合并斑片影等表现的18例患者中,9例治愈,治愈率为50.0%,两组差异无统计学意义;联合糖皮质激素治疗14例患者,10例治愈,治愈率为71.4%;未联合糖皮质激素治疗15例患者,9例治愈,治愈率为60.0%;两组差异无统计学意义;4例患者发热时中性粒细胞完全正常、肺部主要表现为单纯磨玻璃影、仅以抗细菌联合激素治疗,完全治愈,治愈率100.0%,剩余25例患者中,15例治愈,治愈率60.0%,两组差异有统计学意义(P<0.05)。结论化疗结束后,中性粒细胞已恢复正常,肺部CT主要表现为单纯磨玻璃影的患者,可不必加用抗真菌治疗;因此分析肺部CT非特异表现的具体形式,结合中性粒细胞数值等临床特征,可为临床经验治疗提供指导,减少过度治疗。
Objective To investigate the clinical features, imaging findings and treatment of fever in patients with acute leukemia with pulmonary non-specific imaging changes during chemotherapy. Methods The clinical data of 29 patients with acute leukemia from December 2014 to January 2016 were retrospectively analyzed for the characteristics of fever and pulmonary non-specific imaging changes and for the treatment of 29 patients with acute leukemia. Results Of the 29 patients, 19 were cured and the total cure rate was 65.5%. Of the 11 patients who showed diffuse or multiple glass-filled diffuse glaucoma alone, 10 were cured and the cure rate was 90.9%. On the basis of ground-glass opacity, Among the 18 patients, 9 were cured and the cure rate was 50.0%. There was no significant difference between the two groups. In 14 patients treated with glucocorticoid, 10 patients were cured and the cure rate was 71.4% 15 patients were treated with corticosteroids, and 9 patients were cured. The cure rate was 60.0%. There was no significant difference between the two groups. Neutrophil was normal in 4 patients with fever. Bacteria combined with hormone therapy, completely cured, the cure rate was 100.0%, the remaining 25 patients, 15 cases were cured, the cure rate was 60.0%, the difference between the two groups was statistically significant (P <0.05). Conclusion After the chemotherapy, the neutrophils have returned to normal, and the CT of the lung mainly manifests as simple ground-glass opacity without anti-fungal treatment. Therefore, the specific form of CT non-specific manifestation of the lung is analyzed, combined with the neutrophil Cell number and other clinical features, can provide guidance for the treatment of clinical experience, reduce over-treatment.