非结核分枝杆菌肺病的CT表现：与继发性肺结核CT表现比较

Imaging findings of nontuberculous mycobacterial lung diseases ： a comparison with findings of secondary pulmonary tuberculosis

目的 探讨非结核分枝杆菌肺病的CT表现,并与继发性肺结核的CT表现进行比较.方法 选取上海市肺科医院2009年7月至2012年12月间行薄层CT检查并明确诊断为非结核分枝杆菌肺病的患者共计41例,作为非结核分枝杆菌肺病组（NTM组）;采用系统随机抽样法从同期1026例住院的经菌种鉴定确诊为菌阳的继发性肺结核患者41例,作为继发性肺结核组;对两组患者的CT资料进行回顾性分析.肺部病变的CT表现包括小叶中心性结节、大结节、空洞、实变、支气管扩张、病变分布等因素.采用x2检验进行单因素分析,采用logistic回归方法进行多因素检验,P＜0.05为差异有统计学意义.结果 基于单因素分析：支气管扩张常见于NTM组[95.1％（39/41）vs 12.2％（5/41）,x2＝53.408,P＜0.001];实变[7.3％（3/41）vs 31.7％（13/41）,x2＝6.290,P＝0.012]则多见于继发性肺结核组.logistic回归结果显示支气管扩张是NTM肺病与继发性肺结核区分的重要征象（β＝5.613,Wald x2＝22.717,P＜0.001,OR＝273.843,95％CI＝27.237～2753.221）.结论 NTM薄层CT表现有一定特征性;在细菌学明确诊断前,NTM薄层CT表现有助于临床诊治.

Objective To explore and compare the characteristics of CT imaging in nontuberculous mycobacterial （NTM） lung disease with secondary pulmonary tuberculosis.Methods From July 2009 to Dec 2012,41 patients which were confirmed as nontuberculous mycobacterial lung disease admitted in Shanghai Pulmonary Hospital were enrolled as study group,and 41 patients with smear-or culture-positive secondary pulmonary tuberculosis were enrolled from 1026 patients admitted in the same hospital using systematic random sampling as control.The data of thin-section chest CT imaging were analyzed retrospectively.The patterns of lung lesions,including centrilobular nodules,large nodules,cavity,consolidation,bronchiectasis,distribution of lesions,were compared.Statistical comparisons were performed with the t-tests for univariate analysis,and a logistic regression method was used for multivariate analysis.Results Based on univariate analysis,bronchiectasis （（95.1％,39/41） vs （12.2％,5/41）,x2 =53.408,P＜0.001） was more frequently seen in NTM patients.On the other hand,consolidation （（7.3％,3/41） vs （31.7％,13/41）,x2 =6.290,P =0.012） were more frequently seen in secondary pulmonary tuberculosis patients.A logistic regression analysis demonstrated that bronchiectasis was significant CT findings associated with NTM （β＝ 5.613,Wald x2 =22.717,P＜0.001,OR =273.843,95％CI =27.237-2753.221）.Conclusion The thin section CT finding of NTM has certain characteristics which may be helpful to clinical diagnosis for NTM before bacteriological result.