继发性肺结核抗结核治疗后肺内矛盾反应的MSCT观察

Pulmonary Paradoxical Response of Secondary Pulmonary Tuberculosis During Antit Uberculous Therapy Observed by MSCT

目的：探讨继发性肺结核抗结核治疗后肺内矛盾反应的MSCT表现特征。方法：回顾性分析73例继发性肺结核抗结核治疗后CT复查资料，筛检发生肺内矛盾反应的病例，并记录其影像学特征的变化及出现、吸收时间。结果：共发现13例矛盾反应，发生率为17.8％（13／73），可发生在抗结核治疗后3～9个月，以树芽征、腺泡实变融合以及实变进展为主要表现。老年病例易发生矛盾反应发生率44．4％（8／18），高于青壮年的发生率（X^2=10．229，P=0.001〈0.05），以新发腺泡实变融合以及实变进展为主，可发生在抗结核治疗后3～9个月，4～18个月吸收；青壮年矛盾反应发生率9.1％（5／55），以新发树芽征为主，多发生在抗结核治疗后3个月，4～9个月吸收。结论：继发性肺结核治疗过程中肺内矛盾反应并不少见，准确的诊断直接影响进一步的治疗方案，CT复查有助于其诊断。

Objective ： To evaluate the MSCT characteristic of pulmonary paradoxical response of secondary pulmonary tuberculosis during antituberculous therapy. Methods ：The series MSCT signs of 73 patients with secondary pulmonary tuberculosis during antituberculous therapy were retrospectively analysis. The characters, discovered and absorbed time of pulmonary paradoxical responses were recorded. Results ：There were 13 cases with pulmonary paradoxical responses. The incidence rate was 17.8%, which were discovered from 3 months to 9 months. And the signs were tree in-bud, aeinus consolidation and advanced lobular or segment consolidation. The incidence rate of older patients （44.4% ） was higher than that of non-olders （P〈0.05）. New acinus consolidation and advanced lobular or segment consolidation were more found from 3 months to 9 months and absorbed from 4 months to 18 months. The incidence rate in non-older patients was 9.1%. New tree-in-bud was more found in 3 months and absorbed from 4 months to 9 months. Conclusion：Pulmonary paradoxical responses of secondary pulmonary tuberculosis during antituberculous therapy are not a few. The accurate diagnosis affects directly following treatment. The recheck CT could improve the diagnosis accurately.