与耐多药肺结核相关的放射学征象的文献分析

摘要/Abstract

摘要： 背景尽管肺药物敏感结核（DS-TB）和耐多药结核（MDR-TB）的诊断需要微生物检查证实,但胸部影像学早期识别可疑MDR-TB可以对诊断过程提供指引。本文对文献资料中与MDR-TB相关的放射学征象进行分析。方法于2018年1月29日搜索PubMed数据库,搜索关键字组合为 “((extensive drug resistant tuberculosis) OR (multidrug-resistant tuberculosis)) AND (CT or radiograph or imaging or X-ray or computed tomography)”,并分析了报道DS-TB和MDR-TB放射学征象的英文文献。结果我们发现和分析了与分析目的有充分相关性的17篇文章。我们将报告的肺MDR-TB病例分为四个类别：①之前治疗过（继发或获得性）的HIV阴性成人MDR-TB;②新发（或原发）HIV阴性成人MDR-TB;③HIV阳性成人MDR-TB;④儿童MDR-TB。肺MDR-TB的常见放射学表现包括：小叶中央小结节、分枝状线征和结节影（树芽征）、斑块或叶实变、空洞和支气管扩张。虽然总体上MDR-TB病例倾向病变更广泛、更容易双侧发病、胸膜受累、支气管扩张,及肺体积缩小;但仅依据这些征象难以作出MDR-TB的鉴别诊断。迄今的文献提示,肺MDR-TB特异性较高的放射学征象是厚壁多发空洞病变(特别是空洞≥3个时),虽然可能其敏感性不高。对于成人HIV阴性患者,与继发MDR-TB一致,新发MDR-TB也可能有较高的空洞病变发生率,估计在70%左右。结论厚壁多发空洞病变是提示MDR-TB诊断最有意义的放射学征象。未来的研究应该细致地量化空洞病变形态特征。

关键词: 鉴别诊断, 结核病, 耐多药, 断层扫描, X线, 肺

王毅翔, MyungJinChung, AliaksandrSkrahin, AlexRosenthal, AndreiGabrielian, MichaelTartakovsky, 于英杰, 陆普选. 与耐多药肺结核相关的放射学征象的文献分析[J]. 新发传染病电子杂志, 2018, 3(4): 244-253.

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