新发、复发活动性肺结核及陈旧性肺结核影像学诊断的比较研究

Comparative study of imaging diagnosis in newly,relapsed active and inactive pulmonary tuberculosis

目的分析新发、复发活动性肺结核及陈旧性肺结核的影像学特征,探讨影像学诊断对结核活动性判断的临床应用价值。方法收集活动性肺结核55例,其中新发34例,复发肺结核21例和陈旧性肺结核50例,对比分析3组肺结核的影像资料。结果活动性影像学征象:小叶中心结节影、树芽征、小叶样实变、亚段以上实变、磨玻璃影、空洞征在新发肺结核中检出率依次为:79.4%、61.8%、67.6%、35.3%、73.5%、41.2%;复发组为71.4%、57.4%、57.1%、33.3%、66.7%、38.1%;陈旧性肺结核分别为20.0%、16.0%、18.0%、2.0%、32.0%、4.0%。新发和复发活动性肺结核在活动性影像征象检出率方面比较差异无统计学意义(P>0.05),但与陈旧性肺结核比较差异有统计学意义(P<0.05)。非活动性影像学征象:纤维条索影、钙化、支气管扩张、肺气肿在新发肺结核中检出率依次为:8.8%、11.8%、8.8%、5.8%;复发组为52.4%、71.4%、38.1%、38.1%;陈旧性肺结核分别为84.0%、78.0%、44.0%、80.0%。纤维条索影、肺气肿检出率在3组间比较,差异有统计学意义(P<0.05)。钙化和支气管扩张在复发与陈旧性肺结核中的检出率比较,差异无统计学意义(P>0.05),但与新发肺结核比较,差异有统计学意义(P<0.05)。结论活动性影像学征象有助于活动性肺结核的诊断,但尚需密切结合临床和痰检检查。

Objective To explore imaging characteristics in newly, relapsed active and inactive pulmonary tuberculosis, and to investigate the clinical value of the radiological diagnosis in active tuberculosis. Methods Comparison research was adopted in 55 active PTB cases, including 34 newly and 21 relapsed PTB cases and 50 inactive PTB cases. The difference of the imaging manifestations among the three kinds of PTB cases were observed. Results Active imaging symptoms： the check-out rates of centrilobular nodules, tree-in-bud sign, lobular consolidation, segmental and subsegmental consolidation, ground-glass opacity and cavity were 79.4%, 61.8%, 67.6%, 35.3%, 73.5%, 41.2% in newly diagnosed cases; 71.4%, 57.4%, 57.1%, 33.3%, 66.7%, 38.1% in relapsed cases and 20%, 16%, 18%, 2%, 32%, 4% in inactive cases. There was not significant difference of the above check-out rates between newly and relapsed cases, while there was significant difference compared with the inactive cases. Inactive imaging symptoms： the check-out rates of the fiber rope band, calcify, bronchiectasis and emphysema were 8.8%, 11.8%, 8.8%, 5.8% in newly diagnosed cases; 52.4%, 71.4%, 38.1%, 38.1% in relapsed cases and 84%, 78%, 44%, 80% in inactive cases. The difference of the rates of the fiber rope band and emphysema was significant among three kinds of PTB cases. There was not significant difference of the rates of calcify and bronchiectasis between relapsed and the inactive cases, while there was significant difference compared with the newly cases. Conclusion Active imaging manifestations is helpful to the diagnosis of the active PTB, while carefully considering the clinical symptoms and sputum examinations are necessary at the same time.