非活动性与活动性肺结核的CT表现分析

doi:10.19982/j.issn.1000-6621.20210713

摘要/Abstract

摘要：

目的: 对比分析非活动性肺结核与活动性肺结核CT表现。方法: 回顾性搜集2020年8月至2021年7月重庆市公共卫生医疗救治中心诊治的181例非活动性肺结核患者(非活动组)和 166例活动性肺结核患者(活动组),分析两组患者的胸部CT表现。结果: 非活动组病变累及1叶者[19.9%(36/181)]和2叶者[25.4%(46/181)]均明显多于活动组[分别为10.8%(18/166)和13.3%(22/166)](χ²值分别为5.392、8.128,P值分别为0.020、0.004),而5叶均受累者[21.5%(39/181)]明显低于活动组[48.2%(80/166)](χ²=27.283,P=0.000);病变在右肺中叶、下叶及左肺下叶者[分别为38.7%(70/181)、45.3%(82/181)、46.4%(84/181)]均明显少于活动组[69.9%(116/166)、77.1%(128/166)、68.7%(114/166)](χ²值分别为33.903、36.657、17.520,P值均为0.000)。非活动组中小片状实变影、干酪性病变、空洞、胸腔积液、纵隔淋巴结肿大和树芽征等CT表现的发生率[分别为22.1%(40/181)、0.6%(1/181)、16.6%(30/181)、0.6%(1/181)、18.8%(34/181)、18.2%(33/181)]均明显低于活动组[分别为80.1%(133/166)、7.2%(12/166)、27.1%(45/166)、31.9%(53/166)、53.6%(89/166)、66.9%(111/166)](χ²值分别为116.598、10.703、5.671、64.868、45.906、84.365,P值分别为0.000、0.001、0.017、0.000、0.000、0.000),但边缘清楚的支气管扩张、薄壁空洞、胸膜钙化、钙化结节、硬结性病变、纤维条索影的发生率[分别为61.3%(111/181)、12.2%(22/181)、10.5%(19/181)、34.8%(63/181)、37.0%(67/181)、91.7%(166/181)]均明显高于活动组[分别为44.0%(73/166)、4.2%(7/166)、3.6%(6/166)、16.9%(28/166)、0.6%(1/166)、27.7%(46/166)](χ²值分别为10.464、7.124、6.135、14.403、70.576、149.222,P值分别为0.001、0.008、0.013、0.000、0.000、0.000)。结论: 非活动性肺结核病变分布较少累及下叶,CT表现以纤维条索影、边缘清楚的支气管扩张、硬结性病变、结节和胸膜钙化更常见。CT检查对肺结核活动性的判断具有重要辅助诊断作用。

关键词: 结核,肺, 诊断, 体层摄影术,X线计算机

Abstract:

Objective: To investigate the CT features in patients with inactive pulmonary tuberculosis and active pulmonary tuberculosis. Methods: All of 181 patients with inactive pulmonary tuberculosis (inactive group) and 166 patients with active pulmonary tuberculosis (active group) diagnosed and treated in Chongqing Public Health Medical Center from August 2020 to July 2021 were retrospectively collected, and CT manifestations in the two groups were analyzed. Results: The percentages of lesions involving one lobe (19.9% (36/181)) and two lobes (25.4% (46/181)) in the inactive group were significantly higher than that in the active group (10.8% (18/166) and 13.3% (22/166), respectively)(χ²=5.392 and 8.128 respectively, and P=0.020 and 0.004, respectively). The percentage of lesions involving 5 lobes (21.5% (39/181)) was significantly lower than that in the active group (48.2% (80/166))(χ ²=27.283, P=0.000). The percentages of lesions in the right middle lobe and lower lobe as well as the left lower lobe (38.7% (70/181), 45.3% (82/181) and 46.4% (84/181), respectively) were also significantly lower than those in the active group (69.9% (116/166), 77.1% (128/166) and 68.7% (114/166))(χ ²=33.903, 36.657, 17.520; Ps=0.000). CT findings: the incidences of patchy consolidation (22.1%, 40/181), caseous lesions (0.6%, 1/181), cavity (16.6%, 30/181), pleural effusion (0.6%, 1/181), lymphadenopathy (18.8%, 34/181) and tree-in-bud signs (18.2%, 33/181) in the inactive group were significantly lower than those in the active group (80.1% (133/166), 7.2% (12/166), 27.1% (45/166), 31.9% (53/166), 53.6% (89/166), 66.9% (111/166))(χ ²=116.598, 10.703, 5.671, 64.868, 45.906 and 84.365, respectively, and P=0.000, 0.001, 0.017, 0.000, 0.000, 0.000, respectively). The incidences of bronchiectasis (61.3%, 111/181), parenchyma cavity (12.2%, 22/181), pleural calcification (10.5%, 19/181), calcified nodules (34.8%, 63/181), sclerosis (37.0%, 67/181) and fibrosclerosis (91.7%, 166/181) in the inactive group were significantly higher than those in the active group (44.0% (73/166), 4.2% (7/166), 3.6% (6/166), 16.9% (28/166), 0.6% (1/166), 27.7% (46/166))(χ ²=10.464, 7.124, 6.135, 14.403, 70.576 and 149.222 respectively, and P=0.001, 0.008, 0.013, 0.000, 0.000 and 0.000, respectively). Conclusion: The lesions of inactive pulmonary tuberculosis in the lower lobe are less distributed, and fibrosclerosis, bronchiectasis, sclerosis, calcified nodules and pleural calcification are more common signs on CT. CT scanning plays an important role in assessing the activity of pulmonary tuberculosis.

Key words: Tuberculosis,pulmonary, Diagnosis, Tomography,X-ray computed

中图分类号:

R521
R81

李春华, 刘雪艳, 唐光孝, 舒伟强, 王媱, 王佳男, 郑娇凤, 李咏梅, 吕圣秀. 非活动性与活动性肺结核的CT表现分析[J]. 中国防痨杂志, 2022, 44(4): 329-335. doi: 10.19982/j.issn.1000-6621.20210713

LI Chun-hua, LIU Xue-yan, TANG Guang-xiao, SHU Wei-qiang, WANG Yao, WANG Jia-nan, ZHENG Jiao-feng, LI Yong-mei, LYU Sheng-xiu. CT features in patients with inactive and active pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(4): 329-335. doi: 10.19982/j.issn.1000-6621.20210713

图/表 3

表1

表2

不同CT表现在两组患者中的分布情况

CT表现		非活动组(181例)			活动组(166例)			χ²值	P值
CT表现		例数	发生率(%)		例数	发生率(%)		χ²值	P值
片状实变影		18	9.9		29	17.5		4.187	0.041
肺不张		24	13.3		18	10.8		0.475	0.491
斑片内钙化		48	26.5		19	11.4		12.627	0.000
干酪性病变		1	0.6		12	7.2		10.703	0.001
空洞		30	16.6		45	27.1		5.671	0.017
CT表现	非活动组(181例)			活动组(166例)			χ²值		P值
CT表现	例数		发生率(%)	例数		发生率(%)	χ²值		P值
薄壁空洞	22		12.2	7		4.2	7.124		0.008
厚壁空洞	7		3.9	38		22.9	27.766		0.000
无壁空洞	7		3.9	17		10.2	5.463		0.019
空洞内壁不光整	4		2.2	36		21.7	32.207		0.000
空洞边缘清晰	21		11.6	2		1.2	15.125		0.000
空洞周围卫星灶	10		5.5	41		24.7	25.391		0.000
空洞壁钙化	5		2.8	3		1.8	0.351		0.554
毁损肺	5		2.8	6		3.6	0.205		0.651
支气管壁增厚	103		56.9	87		52.4	0.707		0.401
充气支气管征	9		5.0	21		12.7	6.463		0.011
边缘清楚的支气管扩张	111		61.3	73		44.0	10.464		0.001
支气管嵌塞	2		1.1	11		6.6	5.869		0.015
纤维条索影	166		91.7	46		27.7	149.222		0.000
边界清楚的纤维条索影	161		89.0	6		3.6	252.575		0.000
网状影	27		14.9	15		9.0	2.815		0.093
小叶间隔增厚	49		27.1	43		25.9	0.061		0.805
小片状实变影	40		22.1	133		80.1	116.598		0.000
磨玻璃影	9		5.0	40		24.1	26.113		0.000
肿块	1		0.6	2		1.2	0.006		0.940
结节	148		81.8	155		93.4	10.533		0.001
边界清楚的结节	145		80.1	2		1.2	220.793		0.000
钙化结节	63		34.8	28		16.9	14.403		0.000
部分钙化结节	70		38.7	17		10.2	37.262		0.000
结节周围晕征	1		0.6	4		2.4	0.998		0.318
硬结性病变	67		37.0	1		0.6	70.576		0.000
小叶中心性结节	75		41.4	102		61.4	13.873		0.000
树芽征	33		18.2	111		66.9	84.365		0.000
心包积液	0		0.0	13		7.8	-^a		0.000
胸腔积液	1		0.6	53		31.9	64.868		0.000
胸膜增厚	129		71.3	99		59.6	5.199		0.023
伴胸膜外脂肪增厚	25		13.8	1		0.6	21.799		0.000
胸膜钙化	19		10.5	6		3.6	6.135		0.013
肺气肿	30		16.6	5		3.0	17.562		0.000
纵隔淋巴结肿大	34		18.8	89		53.6	45.906		0.000
淋巴结钙化	31		17.1	36		21.7	1.155		0.282
肺外结核	4		2.2	32		19.3	25.321		0.000

表2

图1、2

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