“陈旧病变”与结核病的控制

“Old Lesions” and Control of Pulmonary Tuberculosis

目的探讨对"非活动性肺结核"及X线报告中"陈旧病变"的诊断及处理方法。方法选取北京结核病控制研究所近3年患者中600例门诊结核病患者,观察其影像学改变,总结活动肺结核影像改变。结果 600例患者中,大部分病灶经过抗结核药治疗是可以逐渐减少、消失的。有些患者发现时是单纯的钙化病灶,随病情发展,可以出现高密度病灶逐渐增多的情况,有些甚至在治疗中出现硬结性病灶增多情况。有些患者,X线为陈旧病灶,但因为有症状,复查痰菌有阳性,而确定诊断为复发。结论患者病灶情况与细菌毒力,人体免疫力等有密切相关性。病灶密度不能反眏陈旧或非活动。新发现的结核病患者,有可能出现结节状阴影和胸膜增厚的情况,也有可能为高密度阴影。肺结核有复发率,"非活动肺结核"有可能转变为活动性肺结核,因此对X线报告的"陈旧病变"及"非活动肺结核"的诊断和处理仍需建议患者动态观察,定期复查X线及痰菌情况。

Objective To discuss the diagnosis and treatment methods of the X-ray report description“old lesions”and“non active tuberculosis”.Methods The 600 pulmonary tuberculosis patients of Beijing research institute for tuberculosis in the last 3 years were analysed.The imaging changes were observed and the imaging changes of active pulmonary tuberculosis were summarized.Results In 600 patients,most of the lesions could be gradually reduced or disappeared after antituberculous treatment.Some patients were found to have simple calcification lesions.With the development of the disease,high density lesions could gradually increased.Some of them even had increased sclerosis lesions during treatment.In some patients,X-rays were old lesions,but because of symptoms,sputum bacteria was positive,and definite diagnosis was recurrent.Conclusion Patients focus related to bacterial virulence and human immunity.The density of the lesion does not reflct obsolescence or inactivity.New patients with tuberculosis’image would also appear“old lesions”and“non active tuberculosis”,nodular shadows are possible,or pleural thickening,or high density shadow.Tuberculosis has a certain recurrence rate,“Non active tuberculosis”would change active tuberculosis,therefor,it’s still needs to be observed dynamically,periodic cheak X-ray and check phlegm tuberculosis bacterium regular inspection.