非结核分枝杆菌肺病的临床与MSCT表现

Clinical and MSCT manifestations of nontuberculous mycobacteria lung diseases

目的探讨非结核分枝杆菌(NTM)肺病的临床表现与MSCT特征。方法回顾性分析经临床和实验室检查确诊的102例NTM肺病和102例肺结核患者的病历资料与MSCT资料,两组间一般资料、CT征象的比较采用t/χ~2检验。结果 NTM肺病患者临床表现与肺结核类似,主要表现为咳嗽、咳痰、咯血和活动后气促,两组间差异无统计学意义(P均>0.05)。NTM肺病常合并慢性肺部疾病,如肺结核病史、慢性阻塞性肺疾病、肺心病,与肺结核组比较,两组间差异均有统计学意义(P均<0.05)。NTM肺病MSCT主要表现为小叶中心结节(89/102,87.25%)、支气管扩张(67/102,65.69%)、斑片状实变灶(64/102,62.75%),其次为纤维条索灶、薄壁空洞及胸膜增厚,其中小叶中心结节、支气管扩张、薄壁空洞的发生率高于肺结核组(χ~2=3.995、22.675、12.823,P均<0.05),支气管扩张以右中叶和/或左舌叶明显。结论 NTM肺病常合并慢性肺部疾病,CT表现有一定特征性,尤其表现为右中叶和/或左舌叶支气管扩张伴周围小叶中心结节、薄壁空洞,具有以上CT特征且经正规抗结核效果不佳时,应考虑NTM肺病的可能。

Objective To explore the clinical and MSCT manifestations of nontuberculous mycobacteria（NTM）lung diseases.Methods Totally 102 patients with proved NTM lung diseases（NTM group）and 102 patients with pulmonary tuberculosis（TB group）were included in the study.MSCT image and clinical data of patients were retrospectively analyzed.The t/χ~2 test were used to analyze the differences of clinical and imaging findings between two groups.Results The main clinical symptoms of NTM group were cough,expectoration,hemoptysis and shortness of breath after activity,which had no significant differences between two groups（all P〉0.05）.NTM lung diseases patients often associated with chronic lung diseases such as pulmonary tuberculosis,chronic obstructive pulmonary disease,pulmonary heart disease.The differences were significant between two groups（all P〈0.05）.The main CT manifestations of NTM lung diseases included centrilobular nodules（89/102,87.25%）,bronchiectasis（67/102,65.69%）and patchy consolidation（64/102,62.75%）.Secondly,fiber cable disease,thin-wall cavities and pleural incrassation were common found.The detection rate of centrilobular nodules,bronchiectasis and thin-wall cavities in NTM group were significantly higher than those in TB group（χ~2=3.995,22.675,12.823,respectively,all P〈0.05）.Bronchiectasis were often found in the right middle lobe and/or left lingula lobe.Conclusion NTM lung diseases patients often associate with chronic lung disease.The CT manifestations of NTM lung diseases have certain characteristics.Especially when the bronchiectasis occurred in the right middle lobe and/or left lingular lobe and accompany by the centrilobular nodules,thin-wall cavity and antituberculous therapy being invalid,NTM lung diseases should be considered.