目的

探讨多重肺部感染（MMPI）肺病灶超声影像特征及超声引导经皮介入穿刺肺活检（UGPLB）的临床应用价值。

方法

选取2012 年8 月至2024 年2 月南宁市第四人民医院临床初诊疑为MMPI 的患者262 例，经胸部CT、超声检查后对周围型肺病灶成功实施UGPLB，获取肺病变标本作病理组织学诊断/病原体检测，依据确诊的感染病原体种类将入选患者分为MMPI 组与单一病原体肺部感染（SPPI）组；采用χ² 检验比较MMPI 组与SPPI 组患者超声表现的差异，对相关临床资料进行综合分析。

结果

所有肺病灶均成功实施UGPLB 获取肺病变标本行病理组织学诊断及病原体检测，262 例患者中，最终确诊为MMPI 者210 例，其中感染病原体组合主要为结核分枝杆菌+马尔尼菲篮状菌（59 例），其次是结核分枝杆菌+马红球菌（44 例）、结核分枝杆菌+隐球菌（37例）及结核分枝杆菌+肺炎克雷伯杆菌（36 例）；确诊为SPPI 者52 例，感染病原体主要为结核分枝杆菌（22 例），其次是马尔尼菲篮状菌（14 例）。MMPI 组超声测量肺病灶三径均值≥50 mm 的患者比例大于SPPI 组［79.52%（167/210） vs 34.62%（18/52）］，MMPI 组肺病灶内部呈实液混合回声的患者比例大于SPPI 组［62.86%（132/210） vs 21.15%（11/52）］，差异均具有统计学意义（χ²=40.506、29.240，P 均＜0.001）；2 组肺病灶的边界、内部血流信号及合并胸腔积液方面比较，差异均无统计学意义（P均＞0.05）。

结论

MMPI 患者胸部超声特征为肺病灶一般体积较大，内部大多呈实液混合回声，但无明显特异性；对临床高度疑诊MMPI 的患者，UGPLB 可以帮助临床精准诊断和鉴别诊断。

Objective

To explore the ultrasonic imaging characteristics of pulmonary lesions in multiple microbial pulmonary infections （MMPI） and evaluate the clinical value of ultrasound-guided percutaneous lung biopsy （UGPLB） in these conditions.

Methods

Two hundred and sixty-two patients with suspected MMPI from August 2012 to February 2024 at the Fourth People's Hospital of Nanning were selected. After chest CT and ultrasound examinations， UGPLB was successfully implemented for peripheral lung lesions， and the obtained lung lesion samples were subjected to histopathological examination and pathogen detection. The patients were divided into either an MMPI group or a single pathogen pulmonary infection （SPPI） group according to the confirmed pathogen（s）. The ultrasonic manifestations were compared between the MMPI group and SPPI group using the χ² test， and the relevant clinical data were comprehensively analyzed.

Results

All lung lesions were successfully obtained by UGPLB for pathological diagnosis and pathogen detection. Among the 262 patients， 210 were finally diagnosed with MMPI， of which the pathogen combination was mainly Mycobacterium tuberculosis + Marneffei basket （59 cases）， followed by Mycobacterium tuberculosis + Rhodococcus equi （44 cases）， Mycobacterium tuberculosis + Cryptococcus（37 cases）， and Mycobacterium tuberculosis + Klebsiella pneumoniae （36 cases）； 52 patients were diagnosed with SPPI， and the main pathogen was Mycobacterium tuberculosis （22 cases）， followed by Marneffei basket（14 cases）. One hundred and sixty-seven cases （79.52%） in the MMPI group and 18 cases （34.62%） in the SPPI group has a mean lung lesion size of ≥50 mm as measured by ultrasound， and there was a significant difference between the two groups （χ²=40.506， P＜0.001）. There were 132 cases （62.86%） in the MMPI group and 11 cases （21.15%） in the SPPI group with mixed solid and liquid echo in the lung lesions， and there was a significant difference between the two groups （χ²=29.240， P＜0.001）. There was no significant difference in the boundary of lung lesions， internal blood flow signal， or complication with pleural effusion between the two groups （P＞0.05）.

Conclusion

The characteristics of chest ultrasound in patients with MMPI are that the volume of lung lesions is large， and most of them showed mixed echo of solid and liquid， but there was no obvious specificity. For patients with clincially highly suspected MMPI， UGPLB is effectively helpful for the precise and differential diagnosis of MMPI.