| Objective: Acute Leukemia (AL) is a common and frequently occurringdisease of the blood system. Immunodeficiency, the application ofchemotherapy drugs and the use of corticosteroids, etc. make infectionsbecome one of the most common complications and causes of death andpulmonary infection is the most common site of infection. Lung biopsy berestricted because of thrombocytopenia and coagulation abnormalities inducedbleeding as a result of acute leukemia and it,s therapy. Therefore, lung CTscan, especially high resolution CT scan can give reference for clinicaldiagnosis and treatment. We have analyzed the clinical data, CT imagefeatures and clinical anti-infection treatment effect of different microbialinfections of lungs one by one to summarize the correlation between imagefeatures of lung CT scan and effective anti-infection therapy and effectivedrug and provide evidence for early clinical diagnosis of pulmonary infectionand specific treatment.Method: Collect clinical data and lung CT scan information of66patients with AL complicated with pulmonary infection, who were admitted inour hospital from August,2010to December,2011.Clincal data include name,gender, age, hospitalization days, AL types, chemotherapy regimen, bonemarrow remission conditions, clinical manifestation, image features of lunglesions, pleural effusion conditions, agranulocytosis duration, infection ofother complicated parts, pre-hospital infection history, discharge conditions,G-test, C-reactive protein, the existence of hypoalbuminemia, sputum cultureor smear, blood culture and so on. Lung CT scan data come from picturedepartment. We evaluate57patients of66patients given antifungal therapyaccording to efficacy standards of invasive pulmonary fungal infection (IPFI)and divide them into effective antifungal therapy group and ineffectiveantifungal therapy group. We put patients with cured or marked effect or progress into effective antifungal therapy group and patients with no effect ordeath into ineffective antifungal therapy group. We analyze that whether thereis no correlation between effective antifungal therapy group and imagefeatures. According to bacterial infection efficacy standards, we divide66patients into effective anti-bacterial therapy group and ineffectiveanti-bacterial therapy group and analyze whether there is no correlationbetween effective anti-bacterial therapy group and image features. We divideimage features of66patients into nodule, patchy foci, ground-glass opacity,consolidation shadow, cavity, strips sign and batt shape shadow according tosingle image features. Based on the relation between these image features andeffective anti-bacterial therapy drugs, we use χ2test to do statistical analysis.Result:1Divide the pulmonary infection parts of66AL patients into two lungs and asingle lung. In effective antifungal therapy, nodule, for patients who havecavity and nodule with complicated cavity with statistical significance instatistical analysis, there is no statistical significance in the correlationbetween nodule and lung parts (p>0.05). In effective anti-bacterial therapy, forpatients who have strips sign, strips sign complicated with patchy foci, stripssign complicated with ground-glass opacity with statistical significance instatistical analysis, there is no statistical significance in doing statisticalanalysis on the correlation between strips sign and lung parts(p>0.05).2There are11image features of pulmonary infection of66AL patients wecollected. According to these11image features, we further analyze singleimage features. We divide the images of pulmonary infection images intonodule, patchy foci, consolidation shadow, ground-glass opacity, strips sign,batt shape shadow, cavity. The statistical analysis of effective antifungaltherapy patients indicates that there is a correlation between nodule, cavity,nodule complicated with cavity and effective antifungal therapy patients.(nodule: p=0.005, cavity: p=0.013,nodule complicated with cavity: p=0.037),while there is no correlation between patchy foci, consolidation shadow,ground-glass opacity, strips sign, batt shape shadow and effective antifungal therapy patients (p>0.05). In addition, there is a correlation between nodulecomplicated with pleural effusion, nodule complicated with cough and sputumand effective antifungal therapy patients.(nodule complicated with pleuraleffusion: p=0.010, nodule complicated with cough and sputum p=0.034).There is no correlation between nodule complicated with patchy foci,consolidation shadow, ground-glass opacity, halo sign, proximal pleural andeffective antifungal therapy patients.(p>0.05). There is no correlation betweenpatchy foci complicated with consolidation shadow, ground-glass opacity,pleural effusion, cough and sputum and effective antifungal therapy patients.(p>0.05). There is no correlation between cavity complicated withconsolidation shadow, pleural effusion, cough and sputum and effectiveantifungal therapy patients (p>0.05).There is no correlation betweenconsolidation shadow complicated with ground-glass opacity and effectiveantifungal therapy patients.(p>0.05).This study suggests that nodule, cavityand nodule complicated with cavity on lung CT scans may be related to fungalinfection. The statistical analysis of effective anti-bacterial therapy patientsindicates that there is a correlation between strips sign, strips sign complicatedwith patchy foci, strip sign complicated with ground-glass opacity andeffective anti-bacterial therapy patients.(strips sign: p=0.006, strips signcomplicated with patchy foci: p=0.008, strip sign complicated withground-glass opacity: p=0.042). In addition, there is a correlation betweenstrips sign complicated with pleural effusion, cough and sputum and effectiveanti-bacterial therapy patients (both P values are: p=0.008), while there is nocorrelation between nodule, patchy foci, consolidation shadow, ground-glassopacity, batt shape shadow, cavity, their complications and effectiveanti-bacterial therapy patients(p>0.05). This study indicates that strips sign,strips sign complicated with patchy foci, strips sign complicated withground-glass opacity, strips sign complicated with pleural effusion, cough andsputum may be related to bacterial infection.3According to IPFI efficacy standards,among the66patients we collect, thereare57provided with antifungal therapy. In22effective antifungal therapy cases,4cases were cured;10cases had marked effect;8cases had progress.This study indicates that the total effective rate of antifungal therapy is38.6%.12cases' voriconazole treatment is effective, accounting for54.5%.Whenevaluating drug efficiency according to IPFI efficacy standards, we divide thetotal number of cases by the number of the cured cases and cases with markedeffect to calculate drug efficiency. There are7effective cases and14caseswith marked effect in nodular fungal infection patients treated withvoriconazole among effective antifungal therapy patients. Its effective rate is57.1%.66patients collected according to bacterial infection efficacy standardsall apply anti-bacterial drug therapy. Among them,14cases were effective,among which there is one cured case,6cases with marked effect and7caseswith progress. This study indicates that the total effective rate is21.2%. In14effective anti-bacterial therapy patients, there are7effective cases treated withcarbapenem antibiotics, accounting for50%. When evaluating drug efficiencyaccording to bacterial infection efficacy standards, we divide the total numberof cases by the number of the cured cases and cases with marked effect tocalculate drug efficiency. There are5effective cases and2cases with markedeffect in bacterial infection patients with strips sign treated with carbapenemantibiotics among effective anti-bacterial therapy patients. Its effective rate is40%.4The Correlation between CT image features of AL complicated withpulmonary infection and Effective Drugs:57cases in66patients were givenantifungal therapy with22effective cases. Voriconazole is the most effectivedrug. In effective antifungal therapy patients, nodule, cavity and nodulecomplicated with cavity have a correlation with lung fungal infection. We findthe application of statistical analysis on fungal nodules treated withvoriconazole has statistical significance(p=0.000). We do not find drugs withstatistical significance in cavity and nodule complicated with cavity (All pvalues are: p>0.05).66patients we collected all applied anti-bacterial drugtherapy. Among them, there are14cases in effective anti-bacterial therapygroup. Carbapenem antibiotics is the most effective drug. In effective anti-bacterial therapy patients, strips sign have a correlation with lungbacterial infection. We find the application of statistical analysis on bacterialstrips sign treated with carbapenem antibiotics has statistical significance(p=0.004). Strips sign complicated with ground-grass opacity has acorrelation with lung bacterial infection.We do not find drugs with statisticalsignificance in strips sign complicated with ground-grass opacity, strips signcomplicated with patchy foci, strips sign complicated with pleural effusionand cough and sputum(All p values are: p>0.05).Conclusion1Two lungs infection is the main part of pulmonary infection parts of ALpatients, accounting for57.6%of pulmonary infection. But the study suggeststhat the lung image features of effective antifungal and anti-bacterial patientshave no correlation with lung parts.2When there is nodule, cavity and nodule complicated with cavity in lungs ofAL complicated with pulmonary infection patients, fungal infection should beconsidered. When there is strips sign, strips sign complicated withground-grass opacity, strips sign complicated with patchy foci, strips signcomplicated with pleural effusion and cough and sputum in patients' lungs,bacterial infection should be considered.3The effective rate of voriconazole treatment for AL complicated withpulmonary infection patients with nodular fungal infection is the highest,which is57.1%. Voriconazole can be a choice for treatment under thiscondition. When there is strips sign in lung infection patients, the effectiverate of carbapenem antibiotics treatment is the highest, which is40%.Carbapenem antibiotics can be a choice for treatment under this condition.4In the evaluation of anti-infection efficacy, the total effective rate ofinvasive lung fungal infection patients is38.6%and the total effective rate ofbacterial infection patients' therapy is21.2%. |
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