非结核分枝杆菌肺病与耐多药肺结核的胸部CT征象对照分析

doi:10.3969/j.issn.1004-583X.2021.06.010

摘要/Abstract

摘要：

目的探讨非结核分枝杆菌(NTM)肺病与耐多药肺结核(MDR-TB)CT影像学主要特征的异同,以提高两种疾病鉴别诊断的准确性。方法选取2019年6月-2020年6月在我院治疗的NTM肺病患者41例作为NTM组,从同期收治的MDR-TB患者中选取38例作为MDR-TB组,比较2 组一般资料、CT影像学主要特征以及病变部位的差异。结果 NTM组年龄、合并肺基础疾病比例高于MDR-TB组,病程短于MDR-TB组(P<0.05);NTM组病变特征更多表现为薄壁空洞、检出率高于MDR-TB组(P<0.05);而其厚壁空洞、肺实变、肺不张、肺毁损、肺内钙化、肺门纵隔淋巴结钙化、肺体积缩小、胸膜增厚、胸腔积液检出率均低于MDR-TB组(P<0.05);NTM组病变累及左肺舌叶、右肺中叶的比例高于MDR-TB组(P<0.05);NTM组空洞累及左肺舌叶、右肺中叶的比例高于MDR-TB组(P<0.05);NTM组支气管扩张累及左肺舌叶、右肺中叶的比例高于MDR-TB组(P<0.05);两组结节累及部位无明显差异(P>0.05)。结论 NTM肺病与MDR-TB CT影像学特征较为相似,但亦存在差异,前者更易见薄壁空洞,后者更易见厚壁空洞、肺毁损、肺不张、肺内钙化等多种特征,这可为两者鉴别诊断提供参考依据。

关键词: 非结核分枝杆菌, 广泛耐药结核, 体层摄影术, X线计算机, 诊断, 鉴别

Abstract:

Objective To investigate differences of main CT imaging features between non-tuberculous mycobacterium(NTM) tuberculosis and multi-drug resistant tuberculosis(MDR-TB) for the accuracy of differential diagnosis between the two diseases. Methods The differences of general information, CT imaging features, and lesion locations of the patients were compared between the NTM group (n=41) and mDR-TB group (n=38), the patients were all adimitted to our hospital from Jun 2019 to Jun 2020 were selected. Results Age, the proportion of complicated with pulmonary basic diseases in NTM group were higher than those in MDR-TB group, and the course of disease in NTM group was shorter than that in MDR-TB group (P<0.05) ; The lesions in NTM group were more characterized by thin-wall cavity, and the detection rate in NTM group was higher than those in MDR-TB group (P<0.05); The detection rate of thick-wall cavity, pulmonary consolidation,atelectasis, collapsed lung, lung calcification, hilar mediastinal lymph node calcification, lung volume reduction, pleural thickening, the pleural effusion in NTM group were lower than those in MDR-TB group (P<0.05). The proportion of lesions involved in the ligule lobe of left lung and the middle lobe of right lung in the NTM group was higher than that in MDR-TB group (P<0.05); the proportion of cavity involved in the ligule lobe of left lung and the middle lobe of right lung in the NTM group was higher than that in MDR-TB group (P<0.05); the proportion of bronchiectasis involved in the ligule lobe of left lung and the middle lobe of right lung in NTM group was higher than that in MDR-TB group (P<0.05). There was no significant difference in the site of nodule involvement between two groups (P>0.05). Conclusion The imaging features of NTM tuberculosis and MDR-TB are similar, but there are differences, it is easier for the former to detect thin-wall cavity and for the latter to detect thick-wall cavity, atelectasis, collapsed lung, lung calcification and other characteristics, this can provide reference for the differential diagnosis of the two diseases.

Key words: nontuberculous mycobacteria, extensively drug-resistant tuberculosis, tomography, X-ray computed, diagnosis, differential

中图分类号:

李朝俊, 孙诚鸿, 金文宇. 非结核分枝杆菌肺病与耐多药肺结核的胸部CT征象对照分析[J]. 临床荟萃, 2021, 36(6): 530-534.

Li Chaojun, Sun Chenghong, Jin Wenyu. Comparation of CT imaging characteristics between non-tuberculous mycobacterium tuberculosis and multi-drug resistant tuberculosis[J]. Clinical Focus, 2021, 36(6): 530-534.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.06.010

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I6/530

图/表 6

参考文献 20

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组别	例数	性别[例(%)]			年龄 (岁)		合并肺基础疾病 [例(%)]		病程 (月)		咳嗽 [例(%)]		咳痰 [例(%)]
组别	例数	男	女		年龄 (岁)		合并肺基础疾病 [例(%)]		病程 (月)		咳嗽 [例(%)]		咳痰 [例(%)]
NTM组	41	28(68.29)	13(31.71)		62.59±10.82		27(65.85)		14.12±7.28		29(70.73)		26(63.41)
MDR-TB组	38	24(63.16)	14(36.84)		56.27±12.39		13(34.21)		24.48±9.82		32(84.21)		28(73.68)
t/χ²值		0.231			2.368		7.900		3.883		2.037		0.962
P值		0.631			0.020		0.005		<0.01		0.154		0.327
组别	例数	咯血 [例(%)]		发热 [例(%)]		盗汗 [例(%)]		WBC升高 [例(%)]		Hb降低 [例(%)]		ALB降低 [例(%)]
NTM组	41	11(26.83)		11(26.83)		13(31.71)		17(41.46)		13(31.71)		18(43.90)
MDR-TB组	38	12(31.58)		14(36.84)		8(21.05)		15(39.47)		11(28.95)		15(39.47)
t/χ²值		0.216		0.914		1.147		0.032		0.071		0.159
P值		0.642		0.339		0.284		0.857		0.790		0.690

组别	例数	性别[例(%)]			年龄 (岁)		合并肺基础疾病 [例(%)]		病程 (月)		咳嗽 [例(%)]		咳痰 [例(%)]
组别	例数	男	女		年龄 (岁)		合并肺基础疾病 [例(%)]		病程 (月)		咳嗽 [例(%)]		咳痰 [例(%)]
NTM组	41	28(68.29)	13(31.71)		62.59±10.82		27(65.85)		14.12±7.28		29(70.73)		26(63.41)
MDR-TB组	38	24(63.16)	14(36.84)		56.27±12.39		13(34.21)		24.48±9.82		32(84.21)		28(73.68)
t/χ²值		0.231			2.368		7.900		3.883		2.037		0.962
P值		0.631			0.020		0.005		<0.01		0.154		0.327
组别	例数	咯血 [例(%)]		发热 [例(%)]		盗汗 [例(%)]		WBC升高 [例(%)]		Hb降低 [例(%)]		ALB降低 [例(%)]
NTM组	41	11(26.83)		11(26.83)		13(31.71)		17(41.46)		13(31.71)		18(43.90)
MDR-TB组	38	12(31.58)		14(36.84)		8(21.05)		15(39.47)		11(28.95)		15(39.47)
t/χ²值		0.216		0.914		1.147		0.032		0.071		0.159
P值		0.642		0.339		0.284		0.857		0.790		0.690

组别	例数		累及肺叶(个)						薄壁空洞		厚壁空洞		单发空洞		多发空洞		支气管扩张		肺实变
组别	例数		1~2		3~4		5~6		薄壁空洞		厚壁空洞		单发空洞		多发空洞		支气管扩张		肺实变
NTM组	41		9(21.95)		10(24.39)		19(70.73)		16(39.02)		7(17.07)		1(2.44)		18(43.90)		20(48.78)		10(24.39)
MDR-TB组	38		11(28.95)		12(31.58)		15(39.47)		7(18.42)		15(39.47)		2(5.26)		17(44.74)		17(44.74)		21(55.26)
χ²值					1.462				4.057		4.925		0.431		0.006		0.130		7.884
P值					0.513				0.044		0.026		0.512		0.941		0.719		0.005
组别		例数		肺不张		肺毁损		肺内钙化		肺门纵隔淋巴结钙化		结节		肺体积缩小		胸膜增厚		胸腔积液
NTM组		41		0(0.00)		0(0.00)		10(24.39)		7(17.07)		28(68.29)		4(9.76)		15(36.59)		5(12.20)
MDR-TB组		38		5(13.16)		4(10.53)		27(71.05)		18(47.37)		29(76.32)		13(34.21)		26(68.42)		13(34.21)
χ²值				5.759		4.546		17.246		8.368		0.632		6.983		8.007		5.433
P值				0.016		0.033		<0.01		0.004		0.427		0.008		0.005		0.020

组别	例数		累及肺叶(个)						薄壁空洞		厚壁空洞		单发空洞		多发空洞		支气管扩张		肺实变
组别	例数		1~2		3~4		5~6		薄壁空洞		厚壁空洞		单发空洞		多发空洞		支气管扩张		肺实变
NTM组	41		9(21.95)		10(24.39)		19(70.73)		16(39.02)		7(17.07)		1(2.44)		18(43.90)		20(48.78)		10(24.39)
MDR-TB组	38		11(28.95)		12(31.58)		15(39.47)		7(18.42)		15(39.47)		2(5.26)		17(44.74)		17(44.74)		21(55.26)
χ²值					1.462				4.057		4.925		0.431		0.006		0.130		7.884
P值					0.513				0.044		0.026		0.512		0.941		0.719		0.005
组别		例数		肺不张		肺毁损		肺内钙化		肺门纵隔淋巴结钙化		结节		肺体积缩小		胸膜增厚		胸腔积液
NTM组		41		0(0.00)		0(0.00)		10(24.39)		7(17.07)		28(68.29)		4(9.76)		15(36.59)		5(12.20)
MDR-TB组		38		5(13.16)		4(10.53)		27(71.05)		18(47.37)		29(76.32)		13(34.21)		26(68.42)		13(34.21)
χ²值				5.759		4.546		17.246		8.368		0.632		6.983		8.007		5.433
P值				0.016		0.033		<0.01		0.004		0.427		0.008		0.005		0.020

组别	例数	左肺			右肺
组别	例数	上叶前段及尖后段	上叶舌段	下叶	上叶	中叶	下叶
NTM组	41	24(58.54)	31(75.61)	20(48.78)	31(75.61)	29(70.73)	22(53.66)
MDR-TB组	38	26(68.42)	11(28.95)	22(57.89)	34(89.47)	11(28.95)	23(60.53)
χ²值		0.829	17.246	0.658	2.600	13.775	0.379
P值		0.362	<0.01	0.417	0.107	<0.01	0.538