鸟-胞内分枝杆菌肺病与耐多药肺结核的多层螺旋CT特征比较

doi:10.3969/j.issn.2095-9400.2021.07.008

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摘要目的：探讨鸟-胞内分枝杆菌（MAC）肺病与耐多药性肺结核（MDR-TB）的多层螺旋CT（MSCT）的表现异同。方法：回顾性分析经菌种鉴定的MAC肺病41例（MAC肺病组）和同时期经1:1病例匹配的MDR-TB 41例（MDR-TB组）的MSCT表现，比较2组间差异。结果：MAC肺病组薄壁空洞检出率为69.2%，高于MDR-TB组的30.6%，MAC肺病组空洞平均壁厚为2.5（1.8，3.3）mm，低于MDR-TB组的3.9（2.7，5.0）mm（均P ＜0.001）；MAC肺病组空洞外壁分叶或毛刺征象、空洞周围卫星灶、引流支气管征检出率分别为53.8%、49.2%、27.7%，低于MDR-TB组的79.6%、93.9%、67.3%（均P ＜0.05）；MAC肺病组支气管扩张检出率、支气管扩张累及范围≥3肺叶、右肺中叶、左肺舌叶及左肺下叶支气管扩张检出率、柱状支气管扩张、支气管扩张伴小叶中心结节检出率分别为73.2%、43.9%、63.4%、48.8%、22.0%、53.3%、56.1%，高于MDR-TB组的46.3%、9.8%、12.2%、2.4%、4.9%、21.1%、24.4%（均P ＜0.05）；MAC肺病组囊状支气管扩张占比13.3%，低于MDR-TB组的47.4%（P ＜0.05）；MAC肺病组＞1 cm结节/球形肿块检出率为22.0%，低于MDR-TB组的68.3%（P ＜0.001）。结论：MAC肺病与MDR-TB的MSCT表现比较有一定的特异性，空洞类型、支气管扩张分型及分布优势部位、结节的大小有鉴别意义，有助于临床诊断。

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关键词 ：鸟-胞内分枝杆菌, 结核, 肺, 体层摄影术, X线计算机

Abstract：Objective: To investigate the similarities and differences of imaging features of multislice spiral CT (MSCT) between pulmonary disease due to mycobacterium avium-intracellularis and multi-drug resistant tuberculosis. Methods: The difference of MSCT images between 41 cases of MAC lung disease (MAC group) identified by bacteria and 41 cases of MDR-TB (MDR-TB group) matched by 1:1 was analyzed retrospectively.Statistical analysis was performed. Results: The detection rate of thin-walled cavity in the MAC group was 69.2%,higher than that in the MDR-TB group; average wall thickness in MAC group was 2.5 (1.8, 3.3)mm, while it was 3.9 (2.7, 5.0)mm in MDR-TB group. The differences were all statistically significant (P<0.001). The detection rate of lobular of outer wall of cavity or burr sign, satellite focus of cavity and drainage bronchus in MAC group was 53.8%, 49.2% and 27.7%, respectively, lower than those in the MDR-TB group (79.6%, 93.9%, 67.3%,respectively) with significant differences (P<0.05). The detection rate of bronchiectasis in the MAC group,bronchiectasis involvement range ≥3 lung lobes, right lung middle lobe, left lung tongue lobe, and left lower lobe bronchiectasis detection rate, columnar bronchiectasis, bronchiectasis with lobular central nodules wasrespectively 73.2%, 43.9%, 63.4%, 48.8%, 22.0%, 53.3%, 56.1%, higher than the MDR-TB group (46.3%, 9.8%,12.2%, 2.4%, 4.9%, 21.1%, 24.4% respectively). The differences were statistically significant (P<0.05). The proportion of cystic bronchiectasis in the MAC group (13.3%) was lower than MDR-TB group (47.4%) with statistical difference (P<0.05). The detection rate of nodules/spherical masses in the MAC group > 1 cm was 22.0%, and compared with 68.3% in the MDR-TB group, there was statistical difference (P<0.001). Conclusion:The MSCT manifestations of MAC lung disease and MDR-TB lung disease have their own specificity. The type of cavities, the type of bronchiectasis, dominant location and distribution, and the size of nodules are of differential significance, which are helpful for clinical diagnosis.

Key words： mycobacterium avium-intracellular complex tuberculosis lung tomography X-ray computer

收稿日期: 2020-11-25

通讯作者: 季文斌，教授 E-mail: jiwb@enzemed.com。

作者简介: 周荣真，主治医师，Email：zhourz@enzemed.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.07.008 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I7/564

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