耐多药肺结核并发糖尿病患者胸部CT扫描特征分析

Analysis of CT characteristics of multi-drug resistant pulmonary tuberculosis complicated with diabetic mellitus

目的分析耐多药肺结核并发糖尿病患者与未并发糖尿病患者的胸部CT表现,以提高临床认识。方法通过《首都医科大学附属北京胸科医院病案电子化管理系统》,搜集2012—2017年经改良罗氏培养基痰培养及绝对浓度法药物敏感性试验(简称“药敏试验”)确诊的耐多药肺结核且符合排除标准的660例患者资料,按照是否并发糖尿病将患者分为并发糖尿病组(159例,并发组)、未并发糖尿病组(501例,未并发组)。采用数字表法从两组患者中分别随机抽取60例患者进行对照研究,由2名影像科经验丰富医师在不知患者是否并发糖尿病的情况下重新阅读CT片,以记录胸部CT表现及病变分布范围。采用SPSS 17.0软件进行统计学分析,计数资料采用卡方检验或Fisher精确概率检验,计量资料采用非参数检验方法中的曼-惠特妮U检验,以P<0.05为差异有统计学意义。结果并发组患者中的段或叶性实变[48.3%(29/60)]、大结节[26.7%(16/60)]、任何形式空洞[93.3%(56/60)]、胸腔积液[40.0%(24/60)]的发生率明显高于未并发组患者[分别为28.3%(17/60)、11.7%(7/60)、76.7%(46/60)、20.0%(12/60)](χ^2=5.08,P=0.024;χ^2=4.36,P=0.037;χ^2=6.54,P=0.011;χ^2=5.71,P=0.017),而支气管扩张[45.0%(27/60)]的发生率明显低于未并发组[70.0%(42/60)](χ^2=7.67,P=0.006);且并发组患者中的段性或叶性实变累及叶数[(0.78±0.96)个]、大结节累及肺叶数[(0.48±0.96)个]和任何形式空洞累及叶数[(2.05±1.43)个]明显多于未并发组[分别为(0.38±0.72)个、(0.13±0.39)个、(1.58±1.43)个](U=1380.50,P=0.011;U=1511.00,P=0.027;U=1432.00,P=0.046),而支气管扩张累及肺叶数[(0.97±1.37)个]明显少于未并发组[(1.58±1.57)个](U=1335.50,P=0.010)。结论耐多药肺结核并发糖尿病患者CT扫描出现段以上肺实变的频率及分布范围、出现大结节和空洞的频率及累及范围、并发胸腔积液的频率均较未并发糖尿病患者高;而支气管扩张多见于未并发糖尿病患者。

Objective To compare the CT findings of pulmonary multi-drug-resistant tuberculosis with or without diabetic. Methods Data of 660 pulmonary multi-drug-resistant tuberculosis patients were collected. All the patients were from Beijing Chest Hospital affiliated to Capital Medical University between 2012 and 2017 and diagnosed on sputum-positive and results of drug sensitivity test. They were divided into diabetic group (n=159) and non-diabetic group (n=501). A total of 120 patients were randomly selected from the two groups (each n=60), and the signs and distribution in CT images of them were re-diagnosed by two radiologists without information of complications. Data were ananlyzed using SPSS 17.0 software by chi-square test or Fisher exact test. Quantitative data were analyzed by Mann-Whitney U test. P<0.05 was considered statistically significant. Results The segmental or lobar consolidation, large nodules, cavities and pleural effusion in diabetic group were significantly higher than those in non-daibetic group (48.3%(29/60) vs. 28.3%(17/60),χ^2=5.08, P=0.024;26.7%(16/60) vs. 11.7%(7/60),χ^2=4.36, P=0.037;93.3%(56/60) vs. 76.7%(46/60),χ^2=6.54, P=0.011;40.0%(24/60) vs. 20.0%(12/60),χ^2=5.71, P=0.017), so were the number of lobes involved by segmental or lobar consolidation, large nodules and the number of lobes involved by any form of cavities (0.78±0.96 vs. 0.38±0.72, U=1380.50, P=0.011;0.48±0.96 vs. 0.13±0.39, U=1511.00, P=0.027;2.05±1.43 vs. 1.58±1.43, U=1432.00, P=0.046);while bronchiectasis in diabetic group was significantly lower than that in non-daibetic group (45.0%(27/60) vs. 70.0%(42/60),χ^2=7.67, P=0.006;0.97±1.37 vs. 1.58±1.57, U=1335.50, P=0.010). Conclusion The frequency and range of segment or lager consolidation segmental or lobar consolidation, large nodules and cavity, as well as pleural effusion, are higher in patients of pulmonary multi-drug-resistant tuberculosis complicated with diabetic, while the bronchiectasis is more frequent in patients without diabetes mellitus.