鸟-胞内分枝杆菌复合群肺病和脓肿分枝杆菌肺病的CT影像学比较

Comparison of Imaging Manifestations between Mycobacterium avium- intracellulare Complex and Mycobacterium abscessus Pulmonary Diseases

目的探讨鸟-胞内分枝杆菌复合群（MAC）肺病和脓肿分枝杆菌肺病的CT影像学特点。方法回顾性分析2011年1月至2013年10月间在首都医科大学附属北京胸科医院住院并经临床及实验室证实的16例MAC肺病患者和15例脓肿分枝杆菌肺病患者的CT及高分辨率CT（HRCT）的表现。统计学分析采用SPSS13．0软件进行，计数资料采用χ2检验，计量资料采用t检验。两组的CT表现、常见病变的分布特点进行四格表χ2检验。由于患者总例数〈40例，用确切概率法计算统计结果，以P〈0．05为差异有统计学意义。结果两组患者中肺实变影（28／31）、支气管扩张（28／31）、小叶中心性结节影及树芽征（28／31）的影像学表现多见。MAC肺病患者上叶发病优势（10／16）高于脓肿分枝杆菌肺病患者（2／15）（确切概率法，P〈0．01）。MAC肺病患者以空洞型为主（11／16），而脓肿分枝杆菌肺病患者以结节支气管扩张型为主（11／15）（确切概率法，P〈0．05）。MAC肺病患者肺实变、空洞病变、小叶中心性结节影及树芽征累及肺区范围（分别为55／96，33／96，68／96）多于脓肿分枝杆菌肺病患者（分别为26／90，18／90，48／90）（确切概率法，P值分别为〈0．01、〈0．01、〈0．05）。MAC肺病患者于右肺中叶（11／16）及左肺舌叶（12／16）出现肺实变者多于脓肿分枝杆菌肺病（右肺中叶及左肺舌叶均为4／15）（确切概率法，P〈0．05）。结论鸟胞内分枝杆菌复合群（MAC）和脓肿分枝杆菌肺病的CT表现有一定相似性，但亦有各自一审的特点．为临床早期诊断及早期治疗可提供一定的帮助。

Objective To compare the computed tomography （CT） manifestations of non-tuberculous mycobacterium （NTM） pulmonary diseases caused by Mycobacterium avium-intracellulare complex （MAC） and Mycobacterium abscessus. Methods The CT findings of 16 patients with MAC pulmonary disease and 15 patients with Mycobacterium abscessus pulmonary disease confirmed by clinical and laboratory test who admitted in Beijing Chest Hospital, Capital Medical University from Jan 2011 to Oct 2013 were reviewed retrospectively. CT and high resolution computed tomography （HRCT） findings of all patients were analyzed, χ22 test was used to analyze the difference of imaging between MAC and Mycobacterium abscessus pulmonary disease. Results CT manifestations of air space consolidation （28/31）,bronchiectasis （28/31）, centrilobular nodules or ＂tree in bud＂ （28/31） were common in these 2 pulmonary diseases. The upper lobes were more frequently involved in MAC （10/16） than in Mycobacterium absessus pulmonary, disease （2/15）（P〈0. 01）. The cavity pattern were more frequently observed in MAC （11/16） and nodular bronchiectatic pattern was found more in Mycobacterium absessus pulmonary disease （11/15）（P〈0.05）. Air space consolidation, cavity and centrilobular nodules or ＂tree in bud＂ distributed more lung zones in MAC （55/96, 33/96, 68/96, respectively） than in Mycobacterium abscessus pulmonary disease （26/90,18/90,48/90, respectively）（P〈0. 01, P〈0. 01, P〈0. 05）. Consolidation was more common in the middle of the right lung （11/16, P〈0. 05） and the left lung ligule （12/16, P〈0. 05） in MAC pulmonary disease than in Mycobacterium abscessus pulmonary disease （4/15）. Conclusion The CT imaging findings of MAC pulmonary disease and Mycobacterium abscessus pulmonary disease have certain similarities, but have different features. It helps for early diagnosis and treatment in clinical practice.