肺间质改变为主的继发性肺结核的CT诊断价值与疗效评价

Evaluation of CT Diagnostic Value and Curative Effect of Secondary Pulmonary Tuberculosis With Interstitial Lung Involvement

目的观察肺间质改变为主的继发性肺结核CT诊断价值及抗结核治疗的疗效评价。方法选择我院2017年5月—2018年5月收治的34例以肺间质改变为主的继发性肺结核患者作为研究对象,给予抗结核治疗,采用CT、HRCT检查治疗前,治疗后3个月、9个月、12个月病变区域的CT表现,并评价抗结核治疗效果。结果该疾病好发于双肺上叶(23/34),以大片状改变与节段性分布为主要特征,在CT征象主要显示为细网织影,检出率100.00%(34/34);微结节,检出率100.00%(34/34);树芽征,检出率73.53%(25/34);小叶间隔增厚,检出率52.94%(18/34);磨玻璃样密度影,检出率55.88%(19/34);支气管壁增厚,检出率50.00%(17/34);本组患者经抗结核治疗后,各阶段CT征象均出现明显变化,治疗后9个月、治疗结束时,各征象检出率均低于治疗前,差异具有统计学意义(P <0.05),表明治疗有效。结论 CT、HRCT技术能够清晰、客观、准确地显示以肺间质改变为主的继发性肺结核病变特点,并动态评估抗结核治疗效果,有助于诊断治疗的提示、指导与评估。

Objective To observe the diagnostic value of CT in pulmonary tuberculosis with pulmonary interstitial changes and evaluate the efcacy of antituberculous therapy. Methods 34 cases of patients with secondary pulmonary tuberculosis who were admitted to our hospital from May 2017 to May 2018 were studied. Anti-tuberculosis treatment was given, CT and HRCT were used before treatment, 3 months, 9 months, 12 months after treatment, CT fndings of lesion areas, and evaluation of anti-tuberculosis treatment efect. Results The disease was predominant in the upper lobes of both lungs （23/34）. The main features of the disease were large patches and segmental distribution. The main CT findings were fine reticulation. The detection rate was 100.00% （34/34）.The detection rate of micro nodules was 100.00% （34/34）.The detection rate of tree buds was 73.53% （25/34）. The interlobular septum thickened, the detection rate was 52.94% （18/34）.The detection rate of ground glass density was 55.88% （19/34）. The detection rate of bronchial wall thickening was 50.00% （17/34）. After anti-tuberculosis treatment, the CT signs of all stages were signifcantly changed. After 9 months and at the end of treatment, the detection rate of each sign was lower than that before treatment, the diference was statistically signifcant （P 〈 0.05）, indicating that the treatment was efective. Conclusion CT and HRCT can clearly, objectively and accurately show the characteristics of secondary pulmonary tuberculosis with pulmonary interstitial changes, and dynamically evaluate the efect of anti-tuberculosis treatment, which is helpful to prompt, guide and evaluate the diagnosis and treatment.