鸟-胞内分枝杆菌复合群与龟-脓肿分枝杆菌肺病并发支气管扩张的CT征象比较

doi:10.3969/j.issn.1000-6621.2019.02.014

摘要/Abstract

摘要：

目的探讨鸟-胞内分枝杆菌复合群(MAC)肺病与龟-脓肿分枝杆菌肺病并发支气管扩张患者CT征象的差异,提高对两种疾病并发支气管扩张的鉴别诊断水平。方法搜集2017年1—12月在广州市胸科医院门诊及住院治疗并经临床确诊的25例并发支气管扩张的鸟-胞内分枝杆菌复合群肺病患者(简称“A组”)和26例并发支气管扩张的龟-脓肿分枝杆菌肺病患者(简称“B组”),两组患者均为初诊或未经抗结核和抗非结核分枝杆菌(NTM)治疗。对两组患者的CT扫描资料进行回顾性分析,主要就两组患者支气管扩张(CT分型、分布)、肺内病灶的形态(微结节、树芽征、结节、实变等)、伴发空洞(类型、分布)的CT征象特点及并发症发生情况进行对比分析。结果 B组左肺下叶支气管扩张、左肺下叶微结节、肺体积收缩的比率分别为57.69%(15/26)、84.62%(22/26)、61.54%(16/26),均明显高于A组[分别为28.00%(7/25)、56.00%(14/25)、32.00%(8/25)],差异均有统计学意义(χ ²值分别为4.58、5.03、4.46,P值分别为0.032、0.025、0.035)。A组柱状型支气管扩张占52.00%(13/25),高于B组(15.38%,4/26);B组囊状型支气管扩张占50.00%(13/26),高于A组(16.00%,4/25),差异均有统计学意义(χ ²值分别为7.69、6.63,P值分别为0.006、0.010)。结论龟-脓肿分枝杆菌肺病患者的CT表现中,左肺下叶支气管扩张、左肺下叶微结节、肺体积收缩的发生率高于MAC肺病患者;龟-脓肿分枝杆菌肺病多并发囊状型支气管扩张,而MAC肺病多并发柱状型支气管扩张,以上特征性CT征象有助于两种疾病的鉴别。

关键词: 肺疾病, 分枝杆菌感染,鸟,细胞内, 分枝杆菌,龟亚科, 体层摄影术,X线计算机, 诊断显像, 对比研究

Abstract:

Objective To discuss the CT imaging features of Mycobacterium avium intracellulare complex (MAC) lung disease and Mycobacterium chelonei and abscessus lung disease combined with bronchiectasis, and to improve the differential diagnosis of two diseases. Methods A retrospective analysis of the CT imaging data of 25 cases of MAC lung disease combined with bronchiectasis (Group A) and 26 cases of Mycobacterium chelonei and abscessus lung disease combined with bronchiectasis (Group B). All cases were treated in outpatient or inpatient and were diagnosed clinically in Guangzhou Chest Hospital from January 2017 to December 2017. CT imaging data of patients who were initial diagnosis or had not received anti-NTM treatment were collected. The CT findings and complications of the two groups were compared and analyzed, including bronchiectasis (CT classification, distribution), lung lesions (micronodule, tree in bud, nodules, consolidation, etc.), and cavities (type, distribution). Results There were bronchiectasis, micronodule, tree in bud and thin-walled cavities in two groups. The rates of bronchiectasis in the left lower lobe, micronodules in the left lower lobe, pulmonary consolidation in the right upper lobe and lung volume reduction of Mycobacterium chelonei and abscessus lung disease were 57.69% (15/26), 84.62% (22/26), and 61.54% (16/26) respectively, which was higher than that in MAC lung disease (28.00% (7/25), 56.00% (14/25), 32.00% (8/25)). There was significant statistical differences (χ ²=4.58, 5.03, 4.46, P=0.032, 0.025, 0.035). The cystic bronchiectasis (50.00%, 13/26) was common in Mycobacterium chelonei and abscessus lung disease and columnar bronchiectasis (52.00%, 13/25) often occurs in MAC lung disease. There was significant statistical differences (χ ²=7.69, 6.63, P=0.006, 0.010). Conclusion The incidence of bronchiectasis in left lower lobe, micronodule in left lower lobe and lung volume reduction in Mycobacterium chelonei and abscessus lung disease is higher than that in MAC lung disease. The cystic bronchiectasis often occurs in Mycobacterium chelonei and abscessus lung disease and columnar bronchiectasis is common in MAC lung disease. All these CT manifestations are meaningful for their differential diagnosis.

Key words: Lung diseases, Mycobacterium avium-intracellulare infection, Mycobacterium chelonae, Tomography,X-ray computed, Diagnostic imaging, Comparative study

任会丽,陈品儒,陈华,胡锦兴,刘文,方伟军. 鸟-胞内分枝杆菌复合群与龟-脓肿分枝杆菌肺病并发支气管扩张的CT征象比较[J]. 中国防痨杂志, 2019, 41(2): 195-201. doi: 10.3969/j.issn.1000-6621.2019.02.014

Hui-li REN,Pin-ru CHEN,Hua CHEN,Jin-xing HU,Wen LIU,Wei-jun FANG. The comparison of CT imaging features between Mycobacterium avium-intracellulare complex and Mycobacterium chelonei and abscessus pulmonary diseases combined with bronchiectasis[J]. Chinese Journal of Antituberculosis, 2019, 41(2): 195-201. doi: 10.3969/j.issn.1000-6621.2019.02.014

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支气管扩张类型	A组(25例)		B组(26例)		合计 (例)	χ²值	P值
支气管扩张类型	例数	构成比(%)	例数	构成比(%)	合计 (例)	χ²值	P值
柱状型	13	52.00	4	15.38	17	7.69	0.006
囊状型	4	16.00	13	50.00	17	6.63	0.010
静脉曲张型	1	4.00	1	3.85	2	-	1.000^a
混合型	7	28.00	8	30.77	15	0.05	0.828

支气管扩张数量	A组(25例)		B组(26例)		合计 (例)	χ²值	P值
支气管扩张数量	例数	构成比(%)	例数	构成比(%)	合计 (例)	χ²值	P值
3叶及以上	14	56.00	17	65.39	31	0.47	0.493
2叶	7	28.00	5	19.23	12	0.54	0.460
单叶	4	16.00	4	15.38	8	0.00^a	1.000^a

支气管扩张部位	A组(25例)		B组(26例)		合计 (例)	χ²值	P值
支气管扩张部位	例数	比率(%)	例数	比率(%)	合计 (例)	χ²值	P值
右肺上叶	10	40.00	12	46.15	22	0.20	0.657
右肺中叶	22	88.00	21	80.77	43	0.50	0.478
右肺下叶	11	44.00	10	38.46	21	0.16	0.688
左肺上叶	16	64.00	17	65.38	33	0.01	0.918
左肺下叶	7	28.00	15	57.69	22	4.58	0.032

病灶形态特征	右肺上叶	右肺中叶	右肺下叶	左肺上叶	左肺下叶
B组(26例)
微结节	18(69.23)	19(73.08)	18(69.23)	20(76.92)	22(84.62)
结节	3(11.54)	2(7.69)	2(7.69)	3(11.54)	4(15.38)
树芽征	4(15.38)	7(26.92)	7(26.92)	2(7.69)	11(42.31)
实变	5(19.23)	5(19.23)	0(0.00)	7(26.92)	0(0.00)
A组(25例)
微结节	18(72.00)	20(80.00)	19(76.00)	19(76.00)	14(56.00)
结节	1(4.00)	0(0.00)	4(16.00)	1(4.00)	2(8.00)
树芽征	8(32.00)	6(24.00)	5(20.00)	2(8.00)	8(32.00)
实变	0(0.00)	5(20.00)	1(4.00)	4(16.00)	2(8.00)
χ²值^a
微结节	0.05	0.34	0.29	0.01	5.03
结节	0.23^b	-^c	0.24^b	0.23^b	0.15^b
树芽征	1.96	0.06	0.34	0.00^b	0.58
实变	3.38^b	0.00^b	-^c	0.90	-^c
P值^a
微结节	0.828	0.560	0.588	0.938	0.025
结节	0.631^b	0.490^c	0.627^b	0.631^b	0.701^b
树芽征	0.162	0.811	0.560	1.000^b	0.447
实变	0.066^b	1.000^b	0.490^c	0.343	0.235^c

空洞形态	B组(26例)		A组(25例)		合计 (例)	χ²值	P值
空洞形态	例数	比率(%)	例数	比率(%)	合计 (例)	χ²值	P值
虫蚀空洞	4	15.38	1	4.00	5	1.87	0.172^a
薄壁空洞	11	42.31	11	44.00	22	0.01	0.903
厚壁空洞	5	19.23	4	16.00	9	0.00	1.000^a
合计	20	76.92	16	64.00	36	1.02	0.311