60例活动性肺结核治疗转归与随访的多层螺旋CT应用评价

Evaluation of MSCT application in prognosis and follow-up studies of 60 patients with active pulmonary tuberculosis

目的:探讨活动性肺结核治疗转归肺部病变CT表现演变规律,评价CT在肺结核临床转归与随访中的价值。材料和方法:搜集60例获得细菌学治愈的涂阳活动性肺结核,观察治疗前、治疗后和随访6个月时的CT征象变化;并使用呼气末CT扫描,观察小气道阻塞与空气潴留征象,以及与肺功能参数的相关性。结果:在治疗前、治疗疗程结束和6个月随访3个阶段,肺结核活动性CT征象的检出率分别为95.0%、31.7%和1.7%。CT在治疗前活动性判定准确率为95.0%,在疗程结束后的活动性判定准确率为68.3%,在6个月后随访再次判断准确率达96.7%。疗程结束后至6个月CT扫描仍见76.5%(39例)肺内残留病变进一步缩小和吸收。小气道病变的气体潴留在治疗结束后持续存在,气体潴留体积与肺功能指标中FEF50%、MMEF呈显著相关(χ2=10.48,P<0.01)。结论:肺结核CT征象转归滞后于细菌学转归,仅凭CT征象对治疗后肺结核活动性判定存在限度;CT对肺结核细菌学治愈后的继发小气道病变的评价有较高价值。

Objective： To investigate MSCT manifestations after the healing of active pulmonary tuberculosis, and estimate the value of CT in detecting prognosis and follow-up of pulmonary tuberculosis. Material and Methods： Sixty bacteriologically-cured patients with smear-positive puhnonary tuberculosis were included in this study, whose CT manifestations of pretreatment, post-treatment and 6 months follow-up were observed. CT images were also acquired at the end of expiration. The small airway obstruction and air trapping signs were observed, and explored the correlation between the air trapping volume and pulmonary function parameters. Results： In pre-treatment, post-treatment and 6 months follow-up, the detection rate of activity signs in CT was 95.0%, 31.7% and 1.7%, respectively. The accuracy of CT diagnosing the activity of pulmonary tuberculosis was 95.0%, 68.3% and 96.7% in pre-treatment, post-treatment and 6 months follow-up respectively. The residual lesions were found to be reduced in size and absorbed after drug withdrawal for 6 months in 39 cases （76.5%）. Small airway lesions still existed after treatment. The air trapping volume had an obvious correlation with FEF50% and MMEF（χ^2=10.48, P〈 0.01）. Conclusions： The CT manifestations of prognosis are demonstrated later than bacteriology. There is a limitation in as- sessing the activity of pulmonary tuberculosis only by CT signs. CT plays a role in demonstration of secondary small airway changes after bacteriologically cured.