影像诊断在结核病防治服务体系中的应用价值研究

Application value of imaging diagnosis in tuberculosis control and prevention service system

目的研究不同影像学检查技术对肺结核的检出率，明确在现代结核病防治服务体系中影像学的作用和价值。方法回顾性分析武汉市肺科医院2014年门诊和住院收治并经临床综合诊断确诊的新发初治、复发、复治肺结核患者1998例，对比研究其中采用直接数字化x线摄影（DR）、CT、DR＋CT等检查技术对肺结核患者的检出率情况，统计学分析采用X^2检验，以P〈0．05为差异有统计学意义。结果肺结核影像检出率情况：在1998例肺结核患者中，DR的检出率为74．5％（1489／1998），CT检出率为81．2％（1623／1998），DR＋CT检出率为88．2％（1762／1998）。①CT与DR检出率比较，X^2=68．38，P〈0．001。②CT＋DR与DR检出率比较，X^2=294．87，P〈0．001。③CT＋DR与CT检出率比较，X^2=87．03，P〈0．001。④CT、DR、CT＋DR三组检出率比较，X^2=296．29，P〈0．001。1998例肺结核患者经痰涂片检出菌阳患者267例、痰培养阳性患者466例（痰涂片＋痰培养合计检出菌阳患者733例，占36．7％）。病灶组织活检病理检查确诊67例，占3．4％（67／1998）。行临床诊断性抗结核药物治疗后，患者肺部病灶明显吸收而确诊1198例，占60．0％。结论对肺结核采用不同影像学技术进行诊断时，选择DR＋CT检查的诊断检出率达88．2％，非常有利于肺结核的发现、诊断与鉴别诊断。

Objective To investigate the detection rate of pulmonary tuberculosis using different imaging examination technology, in order to clarify its value in modern TB control service system. Methods We retrospec- tively analyzed the detection rate of pulmonary tuberculosis using digital radiography （DR）, computer tomography （CT） and DR plus CT in 1998 cases with new, recurrent or retreatment pulmonary tuberculosis diagnosed according to composite reference standard from inpatients and outpatients in our hospital. The statistical analysis was used by Chi-square test. It was considered significant difference while P value was less than 0. 05. Results The detection rates of pulmonary tuberculosis were 74.5% （1489/1998） in DR, 81.2%（1623/1998） in CT and 88. 2% （1762/1998） in CT plus DR among all cases. The Chi-square values were 68.38 between CT and DR, 294.87 between DR and CT plus DR, 87.03 between CT and CT plus DR, and 296.29 among CT, DR and CT plus DR. The differences of detection rate were significant statistically with all P values less than 0. 001. Two hundred and sixty- seven cases were positive with sputum smear and 466 cases were positive with sputum culture. The detection rate was 36.7%（733/1998） with smear and culture. Sixty-seven cases were confirmed diagnosed with pathological examination by biopsy. One thousand one hundred and ninety-eight cases were confirmed diagnosed with diagnostic chemotherapy. Conclusion The examination using DR plus CT for pulmonary tuberculosis with high detection rate （88. 2%） is beneficial to the finding, diagnosis and differential diagnosis of pulmonary tuberculosis.