肺结核的中医证型与CT影像关系

Relationship between TCM Syndrome Differentiation and CT Imaging of Pulmonary Tuberculosis

目的探讨肺结核CT影像学与其中医证型之间的对应关系,为肺结核的中医证型客观化提供科学依据。方法对经病理证实或临床抗结核治疗后有效、痰菌阳性的96例肺结核患者的CT影像资料进行回顾性分析。结果96例肺结核患者按《中医病症诊断疗效标准》分为肺阴亏虚、阴虚火旺、气阴两虚、阴阳两虚4个证型,分别为38、24、19、15例。病变早期、症状较轻时为肺阴亏虚型,CT表现为病灶累及范围较小;病变进一步发展、症状较重时为阴虚火旺型,CT表现为病灶累及范围较广,厚壁空洞、树芽症、干酪性坏死多见;病程反复,病灶进一步扩大,肺组织损害更加严重为气阴两虚型,CT表现为病灶纤维化表现为主;肺功能不全时为阴阳两虚型,CT表现为肺气肿、肺动脉高压、肺心病等征象。结论 CT检查对肺结核的诊断、病变分型、病情演变进展、判断预后等具有重要意义。肺结核CT影像表现作为望诊的一部分,可以明确肺结核的中医证型与其CT影像学关系,使肺结核的临床中医辩证分型趋于标准化,使中医辩证更为精确,使中医施治效果更为显著。

Objective To investigate the relationship between CT imaging and TCM syndrome differentiation of pulmonary tuberculosis ,and to provide scientific evidence for the objectification of TCM syndrome differentiation of pulmonary tuberculosis.Methods CT images of 96 patients with pulmonary tuberculosis confirmed by pathology ,effective antituberculosis therapy and bacterial sputum culture were analyzed retrospectively. Results According to the Traditional Chinese Medicine Disease Diagnosis and Treatment Standard, these 96 patients with pulmonary tuberculosis were divided into four syndrome types：Lung Yin deficiency （n=38）,fire excess from Yin deficiency （n=24）,both Qi and Yin deficiency （n=19）,and both Yin and Yang deficiency （n=15）.When lesions were detected in the early stage with mild symptoms, syndrome type belonged to Lung Yin deficiency and CT showed smaller lesion range; When lesions developed and symptoms became more serious, syndrome type belonged to fire excess from Yin deficiency and CT showed a wide range of lesions with thick wall cavity ,tree bud signs and caseous necrosis;When the disease showed a more progressive course with a wider range of lesions and more serious lung damage, syndrome type belonged to both Qi and Yin deficiency and CT showed focal fibrosis;When pulmonary insufficiency occurred,syndrome type belonged to both Yin and Yang deficiency and CT showed pulmonary emphysema, pulmonary hypertension and pulmonary heart disease. Conclusion CT scan plays an important role in the diagnosis ,pathological classification,disease progression and prognosis judgment in pulmonary tuberculosis. As a part of the inspection ,CT scan can confirm the relationship between CT imaging and TCM syndrome differentiation of pulmonary tuberculosis,make clinical Chinese medicine dialectical classification of tuberculosis tend to be more standard,make the Chinese medicine dialectical classification become more accurate,and make the therapeutic effect of traditional Chinese medicine become more significant.