老年肺结核48例影像学特征分析

Analysis of imaging features in 48 elder patients with pulmonary tuberculosis

目的 分析总结老年肺结核患者的影像学特点,提高对老年肺结核患者的临床诊治水平. 方法 收集北京结核病控制研究所门诊部2012-01～2012-12确诊并登记治疗的老年肺结核患者共48例,其中男性28例,女性20例,平均年龄（75.88 ±6.76）岁,对患者的影像学资料（包括胸片、胸部CT）及其他临床资料进行回顾性分析.全部患者均摄有X线胸片,32例患者同时有肺CT资料. 结果 48例老年肺结核患者中,病灶位于一个肺野16例,占33.3％,病灶位于2个及2个以上肺野的患者32例,占66.7％;27例（56.2％）患者主要病变位于上肺野,15例（31.3％）患者病变以中下肺为主.病变性质在影像学上表现多样,以渗出、干酪样实变、纤维索条为主要改变;16例（33.3％）可见空洞,合并胸膜改变13例（27.1％）.结论 老年肺结核患者影像表现复杂,部分患者表现不典型,是造成误诊和漏诊的常见原因,需临床医生提高警惕,诊断时胸片与CT相结合,并及时进行结核的其他相关检查.

Objective To analyze the imaging features of pulmonary tuberculosis in elder patients for improving its diagnostic level.Methods The information was collected in 48 cases of pulmonary tuberculosis（28 males and 20 females） from January 2012 to December 2012 in Beijing Research Institute for Tuberculosis Control.The average age was （75.88 ± 6.76）years in all patients.Chest imaging data（including chest plain film and CT chest film） and other clinical data were retrospectively analyzed.All the patients had chest X-ray plain films and 32 of them had chest CT.Results Of 48 cases,16 cases（33.3％） showed lesion involved only one lung field and 32 cases （66.7％） involved two or more lung fields.The tuberculosis lesions were located in upper lung in 27 cases（56.2％） and middle and lower lung in 15 cases（31.3％）.The imagings were complex with the main changes of exudation,caseous consolidation and fibrosis.Sixteen cases （33.3％） had cavities and 13 cases（27.1％） had pleural change.Conclusion The features of pulmonary tuberculosis in elder patients are complex and part of them are untypical,which are the usual reasons of misdiagnosis and missed diagnosis.For the diagnosis of pulmonary tuberculosis in elder patients,chest X-ray and CT should be combined,and other comprehensive measures should also be adopted timely.