鸟-胞内分枝杆菌肺病患者CT影像学特征及其在非结核分枝杆菌肺病中的诊断价值

doi:10.19982/j.issn.1000-6621.20250417

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (2): 256-263.doi: 10.19982/j.issn.1000-6621.20250417

鸟-胞内分枝杆菌肺病患者CT影像学特征及其在非结核分枝杆菌肺病中的诊断价值

季原飞¹, 于霞¹, 王珏², 孙孟言², 贺伟², 吕岩², 侯代伦²(), 李成海²()

¹ 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所/国家结核病临床实验室, 北京 101149
² 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所医学影像科, 北京 101149

收稿日期:2025-10-26 出版日期:2026-02-10 发布日期:2026-02-03
通信作者: 侯代伦,Email:hodelen@126.com;李成海,Email:lichenghai82@163.com
作者简介:注:于霞与季原飞对本文有同等贡献,为并列第一作者
基金资助:
北京市自然科学基金项目(7232019);国家自然科学基金面上项目(82271962);高层次公共卫生技术人才建设项目(G2023-3-004)

The CT imaging features of Mycobacterium avium-intracellulare pneumonia and the diagnostic evaluation of in non-tuberculous mycobacterium pneumonia

Ji Yuanfei¹, Yu Xia¹, Wang Jue², Sun Mengyan², He Wei², Lyu Yan², Hou Dailun²(), Li Chenghai²()

¹ National Clinical Laboratory for Tuberculosis/Beijing Chest Hospital, Capital Medical University/Beijing Institute of Tuberculosis and Thoracic Tumor, Beijing 101149, China
² Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University/Beijing Institute of Tuberculosis and Thoracic Tumor, Beijing 101149, China

Received:2025-10-26 Online:2026-02-10 Published:2026-02-03
Contact: Hou Dailun, Email: hodelen@126.com;Li Chenghai, Email: lichenghai82@163.com
Supported by:
Beijing Natural Science Foundation Project(7232019);General Project of National Natural Science Foundation of China(82271962);Beijing Municipal Public Health Expert Program(G2023-3-004)

摘要/Abstract

摘要：

目的: 对比分析鸟-胞内分枝杆菌(Mycobacterium avium-intracellulare complex,MAC)肺病与其他菌种非结核分枝杆菌(non-tuberculous mycobacteria,NTM)肺病计算机断层扫描(computed tomography,CT)影像征象差异,探究MAC肺病的CT影像学特征,以提高MAC肺病的CT诊断水平。方法: 采用回顾性研究方法,参照入组标准收集2013年1月1日至2021年8月31日首都医科大学附属北京胸科医院收治并明确诊断的259例NTM肺病患者临床资料。其中,138例为MAC肺病患者(MAC组),121例为其他NTM肺病患者(其他NTM组)。采用单因素和多因素二元logistic回归模型分析两组患者的影像学特征(包括斑片影、磨玻璃影、间质性改变、薄壁空洞、厚壁空洞、混合空洞、空洞邻近胸膜局限增厚、支气管管壁增厚、胸膜广泛增厚、肺气肿等),并通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积(AUC)评估其诊断效能,同时使用Delong检验比较联合预测与单一征象的AUC值的差异。结果: MAC组年龄中位数(四分位数)为61.00(54.75,68.25)岁,高于其他NTM组[52.00(42.50,61.00)岁],差异有统计学意义(Z=5.246,P<0.001)。MAC组发生斑片影、间质性改变、厚壁空洞、混合空洞等CT影像的比例[分别为97.10%(134/138)、19.57%(27/138)、65.22%(90/138)、44.20%(61/138)]均明显高于其他NTM组[分别为89.26%(108/121)、4.96%(6/121)、35.54%(43/121)、31.40%(38/121)],差异均有统计学意义(χ²=6.470,P=0.011;χ²=12.372,P<0.001;χ²=22.734,P<0.001;χ²=4.472,P=0.034)。多因素二元logistic回归模型分析结果显示,间质性改变及厚壁空洞与MAC肺病均呈正相关[β=1.045,OR(95%CI)=2.843(1.023~7.900);β=2.239,OR(95%CI)=9.381(2.845~30.937)],而混合空洞与MAC肺病呈负相关[β=-1.452,OR(95%CI)=0.234(0.076~0.721)]。ROC曲线分析显示,斑片影、间质性改变、厚壁空洞及混合空洞单独预测MAC肺病,以及4种影像联合检测MAC肺病的AUC值分别为0.539(95%CI:0.469~0.610)、0.573(95%CI:0.504~0.642)、0.648(95%CI:0.581~0.716)、0.564(95%CI:0.494~0.634)、0.705(95%CI:0.643~0.768),Delong检验显示,厚壁空洞对MAC肺病的诊断效能仅次于联合检测(Z=-3.117,P=0.002),明显高于斑片影、间质性改变和混合空洞(Z=-3.337,P=0.001;Z=-2.296,P=0.022;Z=4.300,P<0.001)。结论: 斑片影、间质性改变、厚壁空洞及混合空洞联合模型对预测MAC肺病具备一定的诊断效能,而厚壁空洞是其中诊断价值最高的一种影像表现。

关键词: 分枝杆菌感染,鸟,细胞内, 非典型性细菌, 疾病特征, 肺疾病, 诊断, 计算机辅助

Abstract:

Objective: To compare and analyze the differences in computed tomography (CT) imaging findings between pulmonary disease caused by the Mycobacterium avium-intracellulare complex (MAC) and pulmonary disease caused by other non-tuberculous mycobacterial (NTM) species, to explore the CT imaging characteristics of MAC pulmonary disease, and to improve the CT diagnostic accuracy for MAC pulmonary disease. Methods: With the retrospective study, the clinical data of 259 patients with confirmed NTM pulmonary diseases admitted to Beijing Chest Hospital, Capital Medical University from January 1, 2013 to August 31, 2021 were collected based on the inclusion criteria. Among them, 138 patients had MAC pulmonary disease (MAC group), and 121 patients had pulmonary disease caused by other NTM species (other NTM group). Univariate and multivariate binary logistic regression models were used to analyze the imaging features (including patchy opacities, ground-glass opacities, interstitial changes, thin-walled cavities, thick-walled cavities, mixed cavities, localized adjacent pleural thickening, bronchial wall thickening, extensive pleural thickening, emphysema, etc.) of the two groups. The diagnostic performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), and the DeLong test was employed to compare the differences in AUC values between the combined prediction and individual imaging signs. Results: The median age (interquartile range) of the MAC group was 61.00 (54.75, 68.25) years, which was higher than that of the other NTM group (52.00 (42.50, 61.00) years), with a statistically significant difference (Z=5.246,P<0.001). The proportions of CT imaging findings such as patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities in the MAC group (97.10% (134/138), 19.57% (27/138), 65.22% (90/138), and 44.20% (61/138), respectively) were significantly higher than those in the other NTM group (89.26% (108/121), 4.96% (6/121), 35.54% (43/121), and 31.40% (38/121), respectively), with statistically significant differences (χ²=6.470, P=0.011; χ²=12.372, P<0.001; χ²=22.734, P<0.001; χ²=4.472, P=0.034). Multivariate binary logistic regression analysis showed that interstitial changes and thick-walled cavities were positively correlated with MAC pulmonary disease (β=1.045, OR (95%CI)=2.843 (1.023-7.900); β=2.239, OR (95%CI)=9.381 (2.845-30.937)), while mixed cavities were negatively correlated with MAC pulmonary disease (β=-1.452, OR (95%CI)=0.234 (0.076-0.721)). ROC curve analysis revealed that the AUC values for predicting MAC pulmonary disease using patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities individually, as well as the combined detection of these four imaging signs, were 0.539 (95%CI: 0.469-0.610), 0.573 (95%CI: 0.504-0.642), 0.648 (95%CI: 0.581-0.716), 0.564 (95%CI: 0.494-0.634), and 0.705 (95%CI: 0.643-0.768), respectively. The DeLong test showed that the diagnostic performance of thick-walled cavities for MAC pulmonary disease was second only to that of the combined detection (Z=-3.117, P=0.002) and was significantly higher than that of patchy opacities, interstitial changes, and mixed cavities (Z=-3.337, P=0.001; Z=-2.296, P=0.022; Z=4.300, P<0.001). Conclusion: The combined model of patchy opacities, interstitial changes, thick-walled cavities, and mixed cavities demonstrates certain diagnostic efficacy in predicting MAC pulmonary disease, with thick-walled cavities being the imaging finding with the highest diagnostic value among them.

Key words: Mycobacterium avium-intracellulare infection, Atypical bacteria, Disease characteristics, Lung diseases, Diagnosis, computer-assisted

中图分类号:

R814
R51

季原飞, 于霞, 王珏, 孙孟言, 贺伟, 吕岩, 侯代伦, 李成海. 鸟-胞内分枝杆菌肺病患者CT影像学特征及其在非结核分枝杆菌肺病中的诊断价值[J]. 中国防痨杂志, 2026, 48(2): 256-263. doi: 10.19982/j.issn.1000-6621.20250417

Ji Yuanfei, Yu Xia, Wang Jue, Sun Mengyan, He Wei, Lyu Yan, Hou Dailun, Li Chenghai. The CT imaging features of Mycobacterium avium-intracellulare pneumonia and the diagnostic evaluation of in non-tuberculous mycobacterium pneumonia[J]. Chinese Journal of Antituberculosis, 2026, 48(2): 256-263. doi: 10.19982/j.issn.1000-6621.20250417

图/表 5

表1

图1~2

表2

图7

表3

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CT征象	MAC组 (138例)	其他NTM组 (121例)	χ²值	P值	CT征象	MAC组 (138例)	其他NTM组 (121例)	χ²值	P值
斑片影	134(97.10)	108(89.26)	6.470	0.011	支气管扩张	115(83.33)	99(81.82)	0.103	0.748
磨玻璃影	34(24.64)	24(19.83)	0.856	0.355	支气管扩张	115(83.33)	99(81.82)	0.103	0.748
磨玻璃影	34(24.64)	24(19.83)	0.856	0.355	支气管管壁增厚	132(95.65)	110(90.91)	2.365	0.124
间质性改变	27(19.57)	6(4.96)	12.372	<0.001	支气管管壁增厚	132(95.65)	110(90.91)	2.365	0.124
间质性改变	27(19.57)	6(4.96)	12.372	<0.001	树芽征	105(76.09)	88(72.73)	0.383	0.536
肺实变	88(63.77)	65(53.72)	2.693	0.101	树芽征	105(76.09)	88(72.73)	0.383	0.536
肺实变	88(63.77)	65(53.72)	2.693	0.101	小叶中心结节	126(91.30)	106(87.60)	0.946	0.331
单发或多发结节	107(77.54)	86(71.07)	1.418	0.234	小叶中心结节	126(91.30)	106(87.60)	0.946	0.331
单发或多发结节	107(77.54)	86(71.07)	1.418	0.234	肺索条影	134(97.10)	119(98.35)	-	0.688^a
团块影	20(14.49)	11(9.09)	1.785	0.181	肺索条影	134(97.10)	119(98.35)	-	0.688^a
团块影	20(14.49)	11(9.09)	1.785	0.181	并发叶性肺不张	11(7.97)	11(9.09)	0.104	0.747
空洞	100(72.46)	60(49.59)	14.289	<0.001	并发叶性肺不张	11(7.97)	11(9.09)	0.104	0.747
空洞	100(72.46)	60(49.59)	14.289	<0.001	肺损毁	13(9.42)	13(10.74)	0.125	0.724
多发	71(51.45)	39(32.23)	9.745	0.002	肺损毁	13(9.42)	13(10.74)	0.125	0.724
多发	71(51.45)	39(32.23)	9.745	0.002	淋巴结肿大	55(39.86)	30(24.79)	6.634	0.010
上叶	83(60.14)	52(42.98)	7.616	0.006	淋巴结肿大	55(39.86)	30(24.79)	6.634	0.010
上叶	83(60.14)	52(42.98)	7.616	0.006	淋巴结钙化	19(13.77)	14(11.57)	0.280	0.597
薄壁(<3mm)	72(52.17)	53(43.80)	1.810	0.179	淋巴结钙化	19(13.77)	14(11.57)	0.280	0.597
薄壁(<3mm)	72(52.17)	53(43.80)	1.810	0.179	胸腔积液	32(23.19)	28(23.14)	0.000	0.993
厚壁	90(65.22)	43(35.54)	22.734	<0.001	胸腔积液	32(23.19)	28(23.14)	0.000	0.993
厚壁	90(65.22)	43(35.54)	22.734	<0.001	胸膜广泛增厚	78(56.52)	45(37.19)	9.662	0.002
混合	61(44.20)	38(31.40)	4.472	0.034	胸膜广泛增厚	78(56.52)	45(37.19)	9.662	0.002
混合	61(44.20)	38(31.40)	4.472	0.034	肺气肿	70(50.72)	44(36.36)	5.396	0.020
牵拉邻近胸膜	81(58.70)	51(42.15)	7.063	0.008	肺气肿	70(50.72)	44(36.36)	5.396	0.020
牵拉邻近胸膜	81(58.70)	51(42.15)	7.063	0.008	钙化	18(13.04)	16(13.22)	0.002	0.966
邻近胸膜局限增厚	92(66.67)	52(42.98)	14.658	<0.001	钙化	18(13.04)	16(13.22)	0.002	0.966

CT征象	β值	${s}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
斑片影	1.220	0.625	3.812	0.051	3.386	0.995~11.521
间质性改变	1.045	0.521	4.014	0.045	2.843	1.023~7.900
空洞
多发	-0.161	0.419	0.147	0.701	0.851	0.374~1.937
上叶	-0.581	0.487	1.425	0.233	0.559	0.216~1.452
厚壁	2.239	0.609	13.522	<0.001	9.381	2.845~30.937
混合	-1.452	0.574	6.407	0.011	0.234	0.076~0.721
牵拉邻近胸膜	0.447	0.462	0.938	0.333	1.564	0.633~3.864
淋巴结肿大	0.301	0.309	0.951	0.329	1.351	0.738~2.475
胸膜增厚	0.279	0.324	0.741	0.389	1.322	0.700~2.495
肺气肿	0.125	0.309	0.165	0.684	1.134	0.619~2.076

CT征象	AUC(95%CI)值	Z值	P值^a	Z值	P值^b	Z值	P值^c	Z值	P值^d
斑片影	0.539(0.469~0.610)	-	-	-	-	-	-	-	-
间质性改变	0.573(0.504~0.642)	-1.349	0.177	-	-	-	-	-	-
厚壁空洞	0.648(0.581~0.716)	-3.337	0.001	-2.296	0.022	-	-	-	-
混合空洞	0.564(0.494~0.634)	-0.749	0.454	0.265	0.791	4.300	<0.001	-	-
联合	0.705(0.643~0.768)	-5.876	<0.001	-4.717	<0.001	-3.117	0.002	-4.550	<0.001

鸟-胞内分枝杆菌肺病患者CT影像学特征及其在非结核分枝杆菌肺病中的诊断价值

The CT imaging features of Mycobacterium avium-intracellulare pneumonia and the diagnostic evaluation of in non-tuberculous mycobacterium pneumonia

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