肺结核患者治愈后肺内残留的非活动性结核病灶的CT特征研究

doi:10.19982/j.issn.1000-6621.20210734

摘要/Abstract

摘要：

目的: 探讨肺结核治愈后肺内残留的稳定的非活动性结核病灶的分布、CT特点及其在长时间无医疗干预情况下的演化情况。方法: 采用回顾性队列分析的方法,搜集2017年5月至2020年7月首都医科大学附属北京胸科医院符合入组标准的100例患者的两次随访CT资料,对两次资料中肺内非活动性病灶的分布、CT形态和特点,以及两次CT中的病灶演化特点进行归纳和分析。结果: 100例肺结核治愈患者最常见的肺内非活动性病灶征象为索条(88.0%)、结节(67.0%)和斑片(63.0%)。人均可检出结节病灶6.5(1.0,8.3)个、斑片病灶1.6(1.0,2.0)个。可见钙化表现、与胸膜粘连、边缘存在索条的结节、斑片及条片病灶发生率分别为92.6%(403/435)、52.9%(54/102)及81.0%(17/21),72.2%(314/435)、93.1%(95/102)及100.0%(21/21),76.6%(333/435)、96.1%(98/102)及100.0%(21/21)。结节、斑片、条片病灶在随访前后两次的检查中横断最大径[6.97(5.44,10.47)mm和6.72(4.87,9.67)mm,18.30(10.67,30.46)mm和16.00(9.59,30.76)mm,42.30(21.63,74.90)mm和41.75(18.75,73.37)mm]和病灶体积[18.03(14.86,77.89)mm³和16.10(14.02,55.04)mm³,201.57(61.02,633.55)mm³和144.29(58.68,612.75)mm³,3224.00(410.50,5265.00)mm³和3138.25(302.08,3865.50)mm³]均显著减少(Z=-10.289,P<0.001;Z=-3.658,P<0.001;Z=-2.312,P=0.021;Z=-7.524,P<0.001;Z=-3.334,P=0.001;Z=-2.194,P=0.028),且结节和斑片的病灶CT均值[157.01(126.24,236.77)HU和211.22(144.96,342.05)HU,19.79(17.22,45.89)HU和31.15(16.16,64.08)HU]显著增加(Z=-10.342,P<0.001;Z=-4.094,P<0.001)。结论: 肺结核治愈患者最常见的肺内非活动性病灶征象为索条、结节和斑片,且多数表现出钙化、与胸膜粘连、边缘存在索条不光整。非完全钙化和纤维化病灶在治疗停药后的随访中表现为体积进行性病灶缩小、密度增加的变化趋势,这种变化对于判断肺内病灶活动性具有重要意义。

关键词: 结核,肺, 预后, 体层摄影术,X线计算机

Abstract:

Objective: To investigate the distribution, CT characterization and evolution of stable inactive tuberculosis lesions in cured patients without medical intervention for a long time. Methods: A retrospective cohort study of 100 patients who met the inclusion criteria from May 2017 to July 2020 at Beijing Chest Hospital, Capital Medical University was conducted. The distribution, CT-morphological characterization, and evolutionary features of inactive intrapulmonary lesions were summarized and analyzed from two groups of follow-up data. Results: The most common signs of inactive intrapulmonary lesions in 100 cured patients were fibrous stripes (88.0%), nodules (67.0%), and patchy opacity (63.0%). 6.5 (1.0,8.3) of nodular lesions and 1.6 (1.0,2.0) of patchy lesions were detected per capita. Nodules, patchy opacity, and strips opacity with visible calcification, pleural adhesions, and poorly defined edges of fibrous stripes on the margins were 92.6% (403/435), 52.9% (54/102) and 81.0% (17/21), 72.2% (314/435), 93.1% (95/102) and 100.0% (21/21), 76.6% (333/435), 96.1% (98/102) and 100.0% (21/21), respectively. Compared with the result of pre- and post-follow-up examination, nodules, patchy opacity, and strips opacity were significantly reduced (Z=-10.289, P<0.001; Z=-3.658, P<0.001; Z=-2.312, P=0.021; Z=-7.524, P<0.001; Z=-3.334, P=0.001; Z=-2.194, P=0.028) in cross-sectional maximum diameter (6.97 (5.44, 10.47) mm and 6.72 (4.87, 9.67) mm, 18.30 (10.67, 30.46) mm and 16.00 (9.59, 30.76) mm, 42.30 (21.63, 74.90) mm and 41.75 (18.75, 73.37) mm), and lesion volume (18.03 (14.86, 77.89) mm³ and 16.10 (14.02, 55.04) mm³, 201.57 (61.02, 633.55) mm³ and 144.29 (58.68, 612.75) mm³, 3224.00 (410.50, 5265.00) mm³ and 3138.25 (302.08, 3865.50) mm³). In the contrary, the mean CT values in nodules and patchy opacity (157.01 (126.24, 236.77) HU and 211.22 (144.96, 342.05) HU, 19.79 (17.22, 45.89) HU and 31.15 (16.16, 64.08) HU) were significantly increased (Z=-10.342, P<0.001; Z=-4.094, P<0.001). Conclusion: The most common signs of inactive intrapulmonary lesions in cured patients with pulmonary tuberculosis were fibrous stripes, nodules, and patchy opacity, and most of them presented as calcification, pleural adhesions, and poorly defined edges of fibrous stripes. Two follow-up data suggested a reduction in volume and elevation in density of incomplete calcification and fibrous lesions, and this finding was significant for determining the activity of pulmonary tuberculosis lesions.

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

中图分类号:

R521
R81

秦李祎, 吕岩, 杨阳, 贾俊楠, 霍凤敏, 李卫民, 吕平欣. 肺结核患者治愈后肺内残留的非活动性结核病灶的CT特征研究[J]. 中国防痨杂志, 2022, 44(4): 336-342. doi: 10.19982/j.issn.1000-6621.20210734

QIN Li-yi, LYU Yan, YANG Yang, JIA Jun-nan, HUO Feng-min, LI Wei-min, LYU Ping-xin. CT features of residual inactive tuberculosis lesions in cured patients of pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(4): 336-342. doi: 10.19982/j.issn.1000-6621.20210734

图/表 4

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表2

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CT征象分类	检出病灶[个 (检出率,%)]	检出患者[例 (检出率,%)]	人均检出病灶 [个,M(Q₁,Q₃)]
确定的非活动性病变(150处)
索条	87(58.0)	88(88.0)	1.0(-)
支气管扩张征	27(18.0)	27(27.0)	1.0(-)
肺气肿	17(11.3)	16(16.0)	1.0(-)
间质受累	15(10.0)	14(14.0)	1.0(-)
肺不张	2(1.3)	2(2.0)	1.0(-)
分支管状影	2(1.3)	2(2.0)	1.0(-)
活动性不确定病变(560处)
结节影	435(77.7)	67(67.0)	6.5(1.0,8.3)
斑片影	102(18.2)	63(63.0)	1.6(1.0,2.0)
条片影	21(3.8)	18(18.0)	1.0(-)
空洞	2(0.3)	2(2.0)	1.0(-)

CT表现	检出个数	钙化病灶 [个(发生率,%)]	与胸膜粘连 [个(发生率,%)]	病灶边缘索条 [个(发生率,%)]
结节影	435	403(92.6)	314(72.2)	333(76.6)
斑片影	102	54(52.9)	95(93.1)	98(96.1)
条片影	21	17(81.0)	21(100.0)	21(100.0)
空洞	2	-	-	-

CT征象	横断最大径[mm,M(Q₁,Q₃)]	体积[mm³,M(Q₁,Q₃)]	CT均值[HU,M(Q₁,Q₃)]
结节影
T1	6.97(5.44,10.47)	18.03(14.86,77.89)	157.01(126.24,236.77)
T2	6.72(4.87,9.67)	16.10(14.02,55.04)	211.22(144.96,342.05)
△T	0.30(0.05,0.57)	1.04(0.00,9.05)	-40.38(-92.76,-13.71)
△T/T1(%)	-	5.42(0.00,13.32)	-
Z值	-10.289	-7.524	-10.342
P值	<0.001	<0.001	<0.001
斑片影
T1	18.30(10.67,30.46)	201.57(61.02,633.55)	19.79(17.22,45.89)
T2	16.00(9.59,30.76)	144.29(58.68,612.75)	31.15(16.16,64.08)
△T	0.33(-0.10,1.75)	30.10(0.00,57.29)	-5.93(-14.89,0.64)
△T/T1(%)	-	12.75(0.00,23.40)	-
Z值	-3.658	-3.334	-4.094
P值	<0.001	0.001	<0.001
条片影
T1	42.30(21.63,74.90)	3224.00(410.50,5265.00)	32.91(18.23,50.88)
T2	41.75(18.75,73.37)	3138.25(302.08,3865.50)	33.06(18.77,58.41)
△T	1.32(0.14,1.90)	221.15(-5.18,1222.63)	0.03(-6.68,3.06)
△T/T1(%)	-	22.68(-1.19,33.06)	-
Z值	-2.312	-2.194	-0.534
P值	0.021	0.028	0.594