天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 628-631.doi: 10.11958/20170018

• 临床研究 • 上一篇    下一篇

非结核分枝杆菌肺病与耐多药肺结核的 CT 影像对比分析

余庭山，沈晓兰，龙显荣，孟家晓，陈训   

  1. 佛山市第四人民医院影像科（邮编 528000）
  • 收稿日期:2017-01-06 修回日期:2017-04-18 出版日期:2017-06-15 发布日期:2017-07-05
  • 作者简介:余庭山（1972），男，本科，副主任医师，主要从事肺部疾病的影像学诊断方面研究

Comparative analysis of CT images of non-tuberculous mycobacterium tuberculosis and multidrug-resistant pulmonary tuberculosis

YU Ting-shan, SHEN Xiao-lan, LONG Xian-rong, MENG Jia-xiao, CHEN Xun   

  1. Department of Radiology, Foshan Fourth People’s Hospital, Foshan 528000, China
  • Received:2017-01-06 Revised:2017-04-18 Published:2017-06-15 Online:2017-07-05

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摘要： 目的 探讨非结核分枝杆菌（NTM）肺病以及耐多药肺结核（MDR-TB）的 CT 影像学表现特点，提高对该 病的鉴别诊断水平。方法 选取我院 2010 年 1 月—2015 年 12 月确诊为 NTM 肺病的 67 例患者（NTM 肺病组）及 同期 103 例 MDR-TB 患者（MDR-TB 组）的 CT 影像资料，比较 2 组影像学表现及病变部位的差异。结果 NTM 肺 病病灶好发双肺上叶尖后段及下叶背段内（Ⅰ区），呈簇状聚集的小叶中心性结节，并伴有支气管扩张以及胸膜下的 薄壁空洞，少见支气管播散灶。MDR-TB 病灶好发于右肺中叶及左肺上叶舌段（Ⅱ区），双肺上叶呈斑片、结节及干 酪样病变，内伴厚壁空洞以及肺内慢性炎症；表现为厚壁空洞、肺实变、肺不张、钙化（肺内）、肺门纵隔淋巴结钙化、 肺体积缩小、胸膜增厚和胸腔积液等。结论 NTM 肺病与 MDR-TB 的胸部 CT 影像表现相似，但亦存在差异，细致 分析影像特征可为临床鉴别诊断提供一定的依据。

关键词: 结核, 肺, 分枝杆菌, 结核, 广泛耐药结核, 体层摄影术, X 线计算机, 诊断, 鉴别, 非结核分枝杆菌肺病

Abstract: Objective To study the computed tomograhpy (CT) features of non-tuberculous mycobacteria (NTM) and multidrug-resistant pulmonary tuberculosis (MDR-TB), and to improve the differential diagnosis of the disease. Methods The CT imaging data of 67 patients diagnosed with NTM pulmonary disease (NTM lung disease group) and 103 patients with MDR-TB (MDR-TB group) were selected from January 2010 to December 2015 in our hospital. The imaging findings and differences in lesion location were compared between two groups. Results Lesions of NTM lung disease occurred in the posterior segment of the posterior and posterior lumbar dorsal (Ⅰ area), clustered lobular central nodules, accompanied by bronchiectasis and subpleural thin wall empty, rare bronchial foci. MDR-TB lesions occurred in the middle lobe of the right lung and the upper lobe of the left lung (Ⅱ area). The upper lung of the lungs were patch, nodules and caseous lesions, with thick wall and chronic lung inflammation, showing thick wall empty, pulmonary consolidation, atelectasis, calcification (lung), hilar mediastinal lymph node calcification, lung volume reduction, pleural thickening and pleural effusion. Conclusion Chest CT images are similar in NTM lung disease and MDR- TB, but there are differences. The detailed analysis of image features can provide a basis for clinical differential diagnosis.

Key words: tuberculosis, pulmonary, mycobacterium tuberculosis, extensively drug- resistant tuberculosis, tomography, X-ray computed, diagnosis, differential, non tuberculosis mycobacterium tuberculosis