非结核分枝杆菌肺病与继发性肺结核的CT表现分析

摘要/Abstract

摘要： 目的探讨非结核分枝杆菌肺病的CT表现特点,提高对非结核分枝杆菌肺病的认识。方法选取经痰、支气管冲洗液或病变组织培养并进行菌种鉴定确诊的42例非结核分枝杆菌肺病患者为观察组,同期选取42例结核分枝杆菌培养阳性继发性肺结核患者为对照组,比较两组患者的病灶分布、部位、病灶形态及性质。结果观察组病变分布广泛,非结核分枝杆菌肺病组病灶累及1个肺叶者占21.43%,小于肺结核组的45.24%,差异有统计学意义（χ²=5.36,P<0.05）;非结核分枝杆菌肺病组病灶累及≥3个肺叶者占50.00%,大于继发性肺结核组的26.19%,两组比较差异有统计学意义（χ²=5.05,P<0.05）;非结核分枝杆菌肺病组病灶位于中叶、舌段者占78.57%,多于肺结核组的30.93%,两组比较差异有统计学意义(χ²=19.2,P<0.05);非结核分枝杆菌肺病组支气管扩张、胸膜下薄壁空洞、肺气肿肺大疱的发生率分别为54.76%、23.81%、28.57%,分别高于继发性肺结核组的19.05%、7.14%、9.52%,差异均有统计学意义(χ²=11.50、4.46、4.94,P均<0.05 );支气管播散灶、钙化灶、磨玻璃影、胸腔积液及纵隔淋巴结肿大的发生率分别为9.52%、16.67%、9.52%、11.90%、16.67%,分别低于继发性肺结核组的40.48%、40.48%、33.33%、30.95%、35.71%,差异均有统计学意义(χ²=10.73、5.83、7.07、4.53、3.94,P均<0.05 );厚壁空洞、浸润性病灶、增殖性结节、纤维索条的发生率两组比较差异无统计学意义（P>0.05）。结论非结核分枝杆菌肺病的胸部CT表现具有分布广,两肺散在柱状扩张的支气管,多发生于右肺中叶及左肺舌段,胸膜下薄壁空洞及空洞周围并柱状支气管扩张、肺气肿、肺大疱多见等特点。

关键词: 非结核分枝杆菌, 肺结核, 体层摄影术, X线计算机

Abstract: Objective To analyze the CT features of non-tuberculous mycobacterial pulmonary disease and improve the cognition about it. Methods 42 cases of Non-tuberculous Mycobacteria infected patients diagnosed by sputum, bronchial washings fluid or pathological tissue culture and species identification were identified as observation group, and 42 patients with mycobacterium tuberculosis culture positive were selected as control group. The distribution, location, morphology and nature of the lesions in the two groups were compared.Results Lesions were widely distributed in the observation group, and the rate of lesion involvement in one lung lobe was 21.43%, lower than 45.24% in the tuberculosis group, with statistically significant differences (χ²=5.36, P<0.05). The rate of lesions involving 3 or more pulmonary lobes in the observation group (50.00%) was higher than that in the tuberculosis group (26.19%), and the difference between the two groups was statistically significant (χ²=5.05, P<0.05). In the non-tuberculous mycobacterial pulmonary disease group, the detection rate of lesions in the middle lobe and tongue segment was 78.57%, which was higher than 30.9% in the tuberculosis group, and the difference between the two groups was statistically significant (χ²=19.2, P<0.05). The incidence of bronchiectasis, thin-walled cavities, and emphysema bullous blisters in non-tuberculous mycobacterial pulmonary disease group was 54.76%, 23.81%, and 28.57%, which were higher than those of tuberculosis group (19.05%, 7.14%, and 9.52%, respectively). The difference between the two groups was statistically significant (χ²=11.50, 4.46 and 4.94, all P<0.05). The incidence of bronchial diffusion, calcification, glassed shadow, pleural effusion and mediastinal lymph node enlargement in non-tuberculous Mycobacterial pulmonary disease group was 9.52%, 16.67%, 9.52%, 11.90% and 16.67%, which were lower than that of the tuberculosis group (40.48%, 40.48%, 33.33%, 30.95% and 35.71%, respectively), and the differences were statistically significant (χ²=10.73, 5.83, 7.07, 4.53 and 3.94, all P<0.05). There was no statistically significant difference in the incidence of thick-walled cavities, infiltrating lesions, proliferating nodules and fibrous cords between the two groups (P>0.05). Conclusion The chest CT findings of non-tuberculous mycobacteria pulmonary disease are characterized by a wide distribution, two lungs scattered in columnar dilated bronchi, obvious lesions in the middle lobe of the right lung and the tongue segment of the left lung, subpleural thin-wall cavity and surrounding cavity with columnar bronchodilation, common emphysema and pulmonary bullae, etc.

Key words: Non-tuberculous mycobacteria, Tuberculosis, Tomography, X-ray computed

许金卫, 张鑫, 陈震. 非结核分枝杆菌肺病与继发性肺结核的CT表现分析[J]. 新发传染病电子杂志, 2020, 5(2): 113-117.

Xu Jinwei, Zhang Xin, Chen Zhen. Comparative analysis of CT findings between non-tuberculous mycobacterial pulmonary disease and secondary pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(2): 113-117.

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