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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (5): 459-464.doi: 10.3969/j.issn.1000-6621.2020.05.009

• 论著 • 上一篇    下一篇

脊柱非结核分枝杆菌病的CT表现特征分析

梁瑞云(), 李城城, 罗杰棋, 方伟军, 任会丽, 黎惠如   

  1. 510095 广州市胸科医院放射科(梁瑞云、方伟军、任会丽、黎惠如),结核内科(李城城);深圳市第三人民医院放射科(罗杰棋)
  • 收稿日期:2020-02-02 出版日期:2020-05-10 发布日期:2020-05-08
  • 通信作者: 梁瑞云 E-mail:442493623@qq.com
  • 基金资助:
    广东省中医药局中医药科研项目(20191252)

Analysis of CT features of spinal non-tuberculous mycobacterial disease

LIANG Rui-yun(), LI Cheng-cheng, LUO Jie-qi, FANG Wei-jun, REN Hui-li, LI Hui-ru   

  1. Department of Radiology,Guangzhou Chest Hospital,Guangzhou 510095,China
  • Received:2020-02-02 Online:2020-05-10 Published:2020-05-08
  • Contact: LIANG Rui-yun E-mail:442493623@qq.com

摘要:

目的 探讨脊柱非结核分枝杆菌病(脊柱NTM病)的CT表现特征,以期提高对脊柱NTM病的诊断水平。方法 回顾性收集广州市胸科医院及深圳市第三人民医院2015年1月至2018年12月确诊的21例脊柱NTM病患者(研究组:广州市胸科医院11例,深圳市第三人民医院10例),同时收集同期经实验室菌种鉴定确诊的符合纳入标准的脊柱结核患者289例,选取同性别、同年龄患者53例(对照组:广州市胸科医院39例,深圳市第三人民医院14例)进行对比研究。通过对两组患者CT扫描征象的对比,分析脊柱NTM病的CT表现特征。结果 研究组病灶累及椎体≥3节、呈多节(≥2节)椎体多形态破坏并存且不累及椎间盘、成骨性骨质破坏的发生率分别为76.19%(16/21)、52.38%(11/21)、57.14%(12/21),对照组分别为43.40%(23/53)、7.55%(4/53)、9.43%(5/53),两组比较差异均有统计学意义(χ 2值分别为6.489、16.035、16.744,P值分别为0.011、<0.001、<0.001)。研究组骨质破坏区内死骨、椎体塌陷后突、椎间盘破坏、椎旁脓肿、硬膜和脊髓受压或受侵的发生率分别为42.86%(9/21)、9.52%(2/21)、38.10%(8/21)、33.33%(7/21)、33.33%(7/21),对照组分别为77.36%(41/53)、49.06%(26/53)、79.25%(42/53)、81.13%(43/53)、75.47%(40/53),两组比较差异均有统计学意义(χ 2值分别为8.170、9.994、11.622、15.681、11.524,P值分别为0.004、0.002、0.001、<0.001、0.001)。结论 脊柱NTM病患者CT扫描更易看到病灶累及椎体≥3节、成骨性骨质破坏、多节椎体多形态骨质破坏并存且不累及椎间盘;与脊柱结核患者CT扫描不同,可为临床早期诊断与治疗提供一定的帮助。

关键词: 脊柱疾病, 结核, 体层摄影术,X线计算机, 诊断显像, 疾病特征, 诊断, 鉴别

Abstract:

Objective To explore the CT features of spinal non-tuberculous mycobacterial disease(spinal NTM disease),in order to improve the diagnosis of spinal NTM disease. Methods A retrospective analysis of 21 patients who diagnosed as spinal NTM disease(study group:11 patients in Guangzhou Chest Hospital and 10 patients in Shenzhen Third People’s Hospital)were collected from Guangzhou Chest Hospital and Shenzhen Third People’s Hospital from January 2015 to December 2018. At the same time,289 patients with spinal tuberculosis who were confirmed by laboratory strain identification and met the inclusion criteria were collected, among them, 53 patients (control group: 39 patients in Guangzhou Chest Hospital and 14 patients in Shenzhen Third People’s Hospital) were selected at the same sex and age to carry out a comparative study.The study compares the CT scanning signs between the two groups,in oder to analyze the CT features of spinal NTM disease. Results The incidence of lesions involving vertebral body ≥3 segments,multi-section (≥2 segments) of vertebral body with multiple forms of destruction without involving the intervertebral disc,osteogenic bone destruction in the study group were 76.19% (16/21), 52.38% (11/21), 57.14% (12/21),respectively,which were 43.40% (23/53), 7.55% (4/53), 9.43% (5/53) in the control group;There were statistically significant differences between the two groups (χ 2=6.489, 16.035, 16.744,respectively;P=0.011,<0.001,<0.001,respectively). The incidence of sequestrum in the area of bone destruction,vertebral collapse, disc destruction, paravertebral abscess, dura and spinal cord compression or invasion in the study group were 42.86% (9/21), 9.52% (2/21), 38.10% (8/21), 33.33% (7/21), 33.33% (7/21),respectively,which were 77.36% (41/53), 49.06% (26/53), 79.25% (42/53), 81.13% (43/53), 75.47% (40/53) in the control group;There were statistically significant differences between the two groups(χ 2=8.170,9.994,11.622,15.681,11.524,respectively;P=0.004,0.002,0.001,<0.001,0.001,respectively). Conclusion The CT scan of spinal NTM disease patients is more likely to see lesions involving vertebral body ≥3 segments,osteogenic bone destruction,multi-section (≥2 segments) of vertebral body with multiple forms of destruction without involving the intervertebral disc;Its CT features are different from those of spinal tuberculosis patients,which can make a contribution for early clinical diagnosis and treatment.

Key words: Spinal diseases, Tuberculosis, Tomography,X-ray computed, Diagnostic imaging, Disease attributes, Diagnosis, differential