简体中文

论著-头颈部

活动性及非活动性肺结核CT征象对不同类型肺结核的鉴别诊断价值

作者:张强军 张晓明

所属单位:陕西省商洛市第二人民医院CT室(陕西 商洛 726000)

PDF

摘要

目的 探讨活动性及非活动性肺 结核CT征象在新发、复发及慢性肺结核中 的表现。方法 以我院放射科收治的148例 肺结核患者作为研究对象,包括45例新 发型结核患者(A组)、53例复发型结核患 者(B组)以及50例慢性结核者(C组),根 据其临床资料进行回顾性分析。结果 A 组、B组活动性CT征象(树芽征、肺实变、 毛玻璃阴影、节段性分布小叶中心结节 影)的检出率明显高于C组,后壁空洞检 出率低于C组,差异显著(P<0.05);A组 活动性CT征象与B组相比,无显著差异(P >0.05)。C组非活动性CT征象(肺气肿、 支气管聚拢迂曲、纤维条索影、钙化)的 检出率明显高于A组、B组,差异显著(P <0.05);B组非活动性CT征象检出率高于 A组,差异显著(P<0.05)。结论 活动性 及非活动性肺结核CT征象在新发、复发及 慢性肺结核中的表现均存在显著差异,其 征象具有一定的特征性,通过对活动性及 非活动性肺结核CT征象进行分析,可对临 床诊治肺结核提供重要依据。

Objective To study manifestations of active and non-active tuberculosis CT signs in emerging, recurrent and chronic pulmonary tuberculosis. Methods One hundred and forty tuberculosis patients admitted by the Radiology Department of the Hospital were selected as research subjecting, including 45 patients with emerging TB patients (Group A), 53 patients with recurrence tuberculosis (Group B), and 50 patients with chronic tuberculosis (Group C), and retrospective analysis was made according to clinical data. Results The positive rate of active CT signs (tree-in-bud sign, pulmonary consolidation and ground glass shadow, segmental distribution lobules center nodular shadow) of patients in Group A and Group Bwere much higher than those of Group C, and the positive rate of posterior wall of patients in Group A and Group B was lower than of patients in Group C, and the difference were significant (P<0.05). Active CT sign of patients in Group A was not of no significant difference when compared to that of patients in Group B(P>0.05). Inactive CT signs of patients in Group C (emphysema, gathered bronchial circuity, fibrosis image, calcification) were significantly higher than those of patients in Group A and Group B, and the differences were significant (P<0.05. The positive rate of inactive CT sign of patients in Group B was higher than that of patients in Group A, and the difference was significant (P<0.05). Conclusion The demonstrations of active and non-active tuberculosis CT signs in emerging, reoccurrence and chronic recurrent pulmonary tuberculosis show significant differences, and their manifestations deliver certain characteristics. Important basis are provided to clinical diagnosis and treatment for tuberculosis through the analysis on active and non active tuberculosis CT signs.

【关键词】螺旋CT;新发型肺结核;复发 型肺结核;慢性肺结核

【中图分类号】R445.3;R521

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.01.021

前言

肺结核是临床比较常见的一种呼吸道疾病,过去临床主要采用X线 胸片进行诊断,它在肺结核患者的诊断和治疗中发挥着重要的作用, 但X线胸片在成像方面存在一定的不足之处,容易出现漏诊、误诊的 情况[1]。这是由于结核痰杆菌经气道到达肺泡之后,局部会首先出现 渗出性改变,在药力作用或患者免疫力增强的情况下,病变可向增殖 方向发展或吸收,反之当细菌病毒能力较强时,或患者免疫能力低下 时,病变可向干酪坏死发展,其富含结核菌的坏死组织可向其他肺野 传播扩散,从而导致新的病损发生,因此CT影像常表现多样,所以CT 逐渐取代X线成为诊断肺结核的主要方式[2-3]。为此,为院以148例肺结 核患者作为研究对象,探讨CT征象在新发、复发及慢性肺结核中的表 现,现将结果报告如下。