浸润性肺结核多层螺旋 CT 特征及其对患者预后的评估价值

MSCT features of invasive pulmonary tuberculosis and its clinical value in evaluation of patients prognosis

目的：观察浸润性肺结核多层螺旋 CT （ MSCT ）特征，并探讨其对患者预后的评价作用。方法选择60例拟诊为浸润性肺结核的患者为研究对象，以痰培养、组织病理学为金标准，评价MSCT对浸润性肺结核的诊断效力。观察并分析浸润性肺结核病灶的分布及形态学特征。将患者分为治愈好转组与恶化死亡组，比较两组肺部病变形态学变化。结果60例患者中，共确诊浸润性肺结核患者45例，MSCT对浸润性肺结核的诊断灵敏度、特异度、阳性预测率、阴性预测率、正确率、误诊率、漏诊率、诊断符合率分别为93.3％、80．0％、93．3％、80．0％、73．3％、20．0％、6．7％和90．0％。上肺多发斑片状影，实变影，多发结节影、空洞影，上肺单侧星月征、枝桠征及晕轮征是浸润性肺结核主要征象。治疗前，治愈好转组与恶化死亡组胸部MSCT征象比较无统计学意义差异（P＞0．05），治疗4周后，治愈好转组渗出性病变比例显著降低，与治疗前及同期恶化死亡组比较（37．5％比76．9％；3．1％比92．3％），差异均有统计学意义（χ2＝5．750、16．541，均P＜0.05）。治疗8周后，治愈好转组渗出、结节及空洞病灶的比例均显著低于恶化死亡组（3．1％比92．3％；0.0％比15．4％；6．2％比38．5％），差异均有统计学意义（χ2＝16．541、5．152、7．302，均P＜0．05）。结论浸润性肺结核的MSCT形态学改变具有一定的特征性，在浸润性肺结核的诊断、鉴别诊断及疗效评估中，MSCT均具有较高的价值。

Objective To observe the MSCT features of invasive pulmonary tuberculosis,and to investigate its effect on the prognosis.Methods 60 patients with invasive pulmonary tuberculosis were selected as the study subjects.The gold standard was in sputum culture and histopathology.The clinical value of MSCT in the diagnosis of invasive pulmonary tuberculosis was evaluated.The distribution and morphological characteristics of the lesions in the invasive pulmonary tuberculosis were observed and analyzed.The patients were divided into the treatment group and the death group.The morphological changes of lung lesions were compared between the two groups.Results In 60 patients,a total of 45 patients with invasive pulmonary tuberculosis were diagnosed,MSCT of infiltrating pulmonary tuberculosis diagnostic sensitivity,specificity,positive predictive rate,negative predictive rate,correct rate,misdiagnosis rate,missed diagnosis rate,diagnostic accordance rate were 93.3%,80.0%,93.3%,80.0%,73.3%,20.0%, 6.7%,90.0%,respectively.On the lung multiple patchy shadow,real change shadow,multiple nodules,cavity shadow, on the unilateral lung syndrome,and branch sign and halo sign is the main sign of invasive pulmonary tuberculosis. Before treatment,MSCT signs of deterioration of chest between the treatment group and death group had no statistically significant difference（P〉0.05）.After 4 weeks of treatment,the proportion of effusion lesions in the treatment group was significantly decreased compared with before and during the same period of treatment（37.5%vs 76.9%;3.1%vs 92.3%）,the differences were statistically significant（χ2 =5.750,16.541,all P〈0.05）.After 8 weeks of treat-ment,the proportions of effusion,nodules and cavity lesions in the treatment group were significantly lower than those in the deteriorated group（3.1% vs 92.3%;0.0% vs 15.4%;6.2% vs 38.5%）,the differences were statistically significant （χ2 =16.541,5.152,7.302,all P〈0.05）.Conclusion Morphological changes of MSCT in invasive pulmonary tuberculosis have certain characteristics.In the diagnosis,differential diagnosis and therapeutic evaluation of invasive pulmonary tuberculosis,MSCT has high value.