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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (7): 719-723.doi: 10.3969/j.issn.1000-6621.2018.07.010

• 论著 • 上一篇    下一篇

尘肺并发肺结核的胸部CT表现分析

刘雪艳,李春华,吕圣秀(),舒伟强,戴欣   

  1. 400036 重庆市公共卫生医疗救治中心放射科
  • 收稿日期:2018-03-20 出版日期:2018-07-10 发布日期:2018-09-07
  • 通信作者: 吕圣秀 E-mail:598341390@qq.com
  • 基金资助:
    重庆市卫生和计划生育委员会医学科研项目(2017MSXM120)

Analysis of chest CT findings of pneumoconiosis complicated with pulmonary tuberculosis

Xue-yan LIU,Chun-hua LI,Sheng-xiu LYU(),Wei-qiang SHU,Xin. DAI   

  1. Department of Radiology of Chongqing Infectious Disease Medical Center, Chongqing 400036, China
  • Received:2018-03-20 Online:2018-07-10 Published:2018-09-07
  • Contact: Sheng-xiu LYU E-mail:598341390@qq.com

摘要:

目的 探讨尘肺并发肺结核的胸部CT表现特点。方法 搜集2015年6月至2016年12月重庆市公共卫生医疗救治中心诊治的96例尘肺并发肺结核的住院患者,回顾性分析96例患者的临床及CT检查资料。对并发结核病变的发生部位、范围、形态、类型及并发其他脏器结核情况进行观察。结果 96例患者中,尘肺Ⅰ期1例,Ⅱ期23例,Ⅲ期72例。受累范围:多肺叶90例(93.8%)。发生部位:尖后段93例(96.9%),前段48例(50.0%),中叶或(和)舌段49例(51.0%),背段68例(70.8%),基底段53例(55.2%)。病变形态:斑片状影85例(88.5%),大片状影48例(50.0%),空洞64例(66.7%)[其中多发空洞占67.2%(43/64)],树芽征56例(58.3%),胸腔积液36例(37.5%),胸膜增厚72例(75.0%),纵隔淋巴结肿大85例(88.5%),纵隔淋巴结钙化58例(60.4%)。Ⅱ期尘肺患者薄壁空洞发生率为47.8%(11/23),高于Ⅲ期尘肺患者[15.3%(11/72)](χ 2=10.378,P<0.05)。Ⅲ期尘肺患者大片状影、树芽征、厚壁空洞、胸膜增厚、纵隔淋巴结肿大及钙化的发生率分别为59.7%(43/72)、69.4%(50/72)、56.9%(41/72)、83.3%(60/72)、93.1%(67/72)、69.4%(50/72),高于Ⅱ期尘肺患者[分别为21.7%(5/23)、26.1%(6/23)、8.7%(2/23)、52.2%(12/23)、78.3%(18/23)、34.8%(8/23)](χ 2值分别为10.061、13.541、14.489、9.224、4.051、8.808,P值均<0.05)。 结论 尘肺不同分期患者并发肺结核CT表现具有一定差异,以浸润灶为主,常伴有多发空洞、树芽征、胸腔积液、肺外结核等。

关键词: 尘肺, 结核, 肺, 共病现象, 体层摄影术, X线计算机, 疾病特征, 诊断显像

Abstract:

Objective To explore the features of chest CT in patients with pneumoconiosis complicated with pulmonary tuberculosis.Methods We analyzed retrospectively the clinical and CT data from 96 cases of pneumoconiosis complicated with pulmonary tuberculosis admitted in Chongqing Infectious Disease Medical Center from June 2015 to December 2016. The location, scope, morphology, type and other organ tuberculosis were observed.Results Of 96 cases, there were pneumoconiosis stage Ⅰ in one case, stage Ⅱ in 23 cases and stage Ⅲ in 72 cases. Pulmonary lesions involved multiple lobes in cases and located at the apicoposterior segment in 93 (96.9%) cases, at the anterior segment in 48 (50.0%) cases, at the middle lobe or/and lingula lobe in 49 (51.0%) cases, at the apical segment of lower lobe in 68 (70.8%) cases and at the basal segment in 53 (55.2%) cases. Of 96 cases, the pathological morphology were patch shadow in 85 (88.5%) cases, large patch shadow in 48 (50.0%) cases, cavity in 64 (66.7%) cases including multiple cavities in 43 cases (67.2%, 43/64), tree-in-bud in 56 (58.3%) cases, pleural effusion in 36 (37.5%) cases, pleural thickening in 72 (75.0%) cases, mediastinal lymph node enlargement in 85 (88.5%) cases, mediastinal lymph node calcification in 58 (60.4%) cases. The incidence of thin-wall cavity in patients with stage Ⅱ pneumoconiosis (47.8%,11/23) was higher than that in patients with stage Ⅲ pneumoconiosis (15.3%,11/72) (χ 2=10.378,P<0.05). The incidence of large patch (59.7%,43/72), tree-in-bud (69.4%,50/72), thick wall cavity (56.9%,41/72), pleural thickening (83.3%,60/72), mediastinal lymph node enlargement (93.1%,67/72) and calcification (69.4%, 50/72) in patients with stage Ⅲ pneumoconiosis were higher than those ((21.7%,5/23),(26.1%,6/23),(8.7%,2/23),(52.2%,12/23),(78.3%,18/23),(34.8%,8/23)) in patients with stage Ⅱ pneumoconiosis, respectively (χ 2=10.061,13.541,14.489,9.224,4.051 and 8.808,P<0.05 for each). Conclusion CT findings of the patients with pulmonary tuberculosis complicated with different stages pneumoconiosis is certain specificity with multiple cavities, tree-in-bud, pleural effusion and extrapulmonary tuberculosis.

Key words: Pneumoconiosis, Tuberculosis, pulmonary, Comorbidity, Tomography, X-ray computed, Disease attributes, Diagnostic imaging