Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: 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. Results: 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 (χ(2)=11.039, P=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 P>0.05) . Conclusion: 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.
目的： 总结血液病患者肺孢子菌肺炎（PJP）的初始肺CT影像特征。 方法： 回顾性分析2014年1月至2021年12月在中国医学科学院血液病医院诊断为PJP的46例血液病患者的临床及影像资料。所有患者均行多次胸部CT及相关实验室检查，依据初始肺CT表现进行影像分型，并分析不同临床特征分组下的不同影像分型分布。 结果： 46例患者中，男33例，女13例，中位年龄37.5（2~65）岁。肺泡灌洗液（BALF）六胺银染色确诊11例、临床诊断35例，临床诊断患者中16例经BALF宏基因组二代测序（BALF-mNGS）诊断、19例经外周血宏基因组二代测序（PB-mNGS）诊断。初始胸部CT表现分为4型，包括磨玻璃型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、BALF-mNGS诊断和PB-mNGS诊断患者的CT类型构成比差异无统计学意义（χ(2)=11.039，P=0.087）。确诊患者和PB-mNGS诊断患者CT表现以磨玻璃型为主（63.6%、73.7%），BALF-mNGS诊断的患者CT表现以结节型为主，占37.5%。63.0%（29/46）的患者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LDH水平升高。不同CT类型患者的外周血淋巴细胞减少率、G试验阳性率和LDH升高率的差异均无统计学意义（P值均>0.05）。 结论： 血液病患者PJP初始肺CT表现多样，以两肺多发磨玻璃影多见，结节型与纤维化型也是PJP初始CT表现。.
Keywords: Hematologic diseases; Pneumonia, pneumocystis; Tomography, spiral computed.