初治活动性肺结核化疗期内类赫氏反应的胸部CT表现

CT Manifestations of Herxheimer Like Reaction Among the New Active Pulmonary Tuberculosis During Chemotherapy

目的探讨初治活动性肺结核病患者在化疗中出现类赫氏反应的胸部CT表现。方法回顾性分析2009年至2011年收治的21例已确诊为类赫氏反应患者的临床和CT影像学资料。结果 21例患者抗痨中主要表现为咳嗽、咳痰、低热和盗汗等症状先缓解后加重,部分患者并有胸痛、胸闷、持续高热等;坚持原化疗方案一定时间后病情明显好转;CT表现为:(1)肺内原发结核灶进展6例,其他肺叶出现新病灶5例,原发结核灶旁新病灶4例,多发肺叶病灶部分进展3例,结核瘤增大2例,结核空洞扩大1例;(2)合并渗出性胸膜炎1例;(3)合并纵隔淋巴结肿大5例。结论在临床正规化疗过程中,若CT表现为原发结核灶进展、其他肺叶出现新病灶、原发结核灶旁新病灶、多发肺叶病灶部分进展部分吸收等征象,要高度怀疑为类赫氏反应。

Objective To explore CT manifestations of Herxheimer like reaction among the new active pulmonary tuber- culosis during chemotherapy. Methods Clinical and image data of 21 cases with Herxheimer like reaction were retrospec- tively analyzed. Results In the period of the antituberculosis treatment in 21 patients, the main clinical manifestations, such as cough, expectoration, low grade fever and night sweat, first alleviate and get more serious afterwards; some patients even appeared chest pain, chest tightness and long term high fever, but the disease was improved obviously after a certain period of the primary chemotherapy treatment. CT manifestations included （ 1 ） 6 cases with pulmonary primary tuberculosis developed, 5 cases with pulmonary tuberculosis complicated with mediastinal lymphadenectasis, 4 cases with new lesions a- round primary tuberculosis fous, 3 cases with tuberculosis of multiple segments partly diffusion, 2 eases with tuberculoma, 1 case with tuberculous cavity expansion; （2） 1 patient suffered from exudative tuberculosis pleurisy; （3） 5 patients suf- fered from pulmonary tuberculosis with mediastinal lymphadenectasis. Conclusion In the course of clinical chemotherapy,if the following symptoms are occurred such as pulmonary primary tuberculosis diffusion, pulmonary tuberculosis with mediastinal lymphadenectasis, new lesions around primary tuberculosis fous, and tuberculosis fous of multiple segments partly diffusion, the patient should be highly suspected of the Herxheimer like reaction.