老年继发性肺结核抗结核治疗后多排螺旋CT征象的演变

MSCT signs evolution of older secondary pulmonary tuberculosis to antituberculous therapy

目的探讨老年继发性肺结核抗结核治疗后多排螺旋CT征象的演变特征。方法回顾性分析18例老年继发性肺结核抗结核治疗后MSCT基本征象的变化,并与44例中青年肺结核随访病例进行对比分析。结果①老年组肺叶/肺段实变和腺泡实变融合的发生率72.2%和88.9%高于对照组(22.7%,45.5%)(P<0.05),吸收多发生在4～12个月,对照组吸收多发生在1～6个月。老年组树芽征发生率5.6%低于对照组(43.2%)(P<0.05),5个月吸收;对照组多在3～9个月吸收。老年组空洞性病变20%完全吸收,对照组50%完全吸收。②老年组治疗过程中矛盾反应发生率44.4%高于对照组的9.1%(P<0.05),可出现在治疗后1～9个月;对照组多出现在3个月以内。结论老年肺结核抗结核治疗后征象吸收缓慢,并且容易发生治疗后矛盾反应,熟悉这些转归特征有利于提高老年肺结核的诊断并且判断其疗效。

Objective To evaluate MSCT signs evolution of older secondary pulmonary tuberculosis to antituberculous therapy.Methods The basic signs and changes to antituberculous therapy of 18 older patients with secondary pulmonary tuberculosis were analyzed retrospectively and contrasted with 44 non-older patients.Results ①The incidence rates of lobular or segment consolidation and acinus consolidation of older patients were 72.2% and 88.9% which were higher than those of control group（22.7%,45.5%）（P〈0.05）.They were absorbed from 4 to 12 months after therapy.Those of control group were absorbed from 1 to 6 months.The incidence rate of tree-in-bud sign of older patients（5.6%）were lower than that of control group（43.2%）（P〈0.05）.It disappeared at 5 months after therapy.Those of control group were absorbed from 3 to 9 months.Only one of older patients with cavitations（20%）was absorbed and 50% of control group were absorbed completely.② Paradoxical responses were discovered in 44.4% of older patients at 1 to 9 months of follow-up,which were higher than those of control group（P〈0.05）.Only 9.1% of control group were discovered that responses in 3 months of therapy.Conclusion The signs and sequential changes of older patients with secondary pulmonary tuberculosis are absorbed slower than those of control group.And more paradoxical responses appear in older patients.To be familiar with those features could diagnose tuberculosis accurately and judge the curative effect reliable.