非结核分枝杆菌肺病的临床与CT特征

Clinical and CT Features of Pulmonary Nontuberculous Mycobacteria

目的:探讨非结核分枝杆菌(NTM)肺病的临床与CT特征。方法:回顾性分析我院经临床和实验室检查确诊的57例NTM肺病患者的临床及CT资料。结果:NTM高发年龄为40~79岁(45/57,78.95%),常见症状依次是咳嗽(47/57,82.46%).咳痰(45/57,78.95%)、咯血(25/57,43.86%)、发热(23/57,40.35%).胸闷(17/57,29.82%),常合并肺部基础疾病包括慢阻肺(6/57,10.53%).陈旧性肺结核(6/57,10.53%)以及支气管扩张(4/57,7.02%)。CT表现为多发小叶中心结节(42/57.73.68%)、支气管扩张(31/57.54.39%)以及空洞(24/57.42.11%)等,小叶中心结节分布无明显特征,支气管扩张以右肺中叶(19/57,33.33%)和/或左肺上叶舌段(14/57,24.56%)为主,空洞以两上肺(右11/57,19.30%;左8/57,14.04%)为主,且多靠近外围胸膜下(18/57,31.58%)。结论:对于有肺部基础疾病的中老年患者,CT上出现多发小叶中心结节、右肺中叶和/或左肺上叶舌段支气管扩张及两上肺薄壁空洞者应考虑到NTM肺病的可能。

Purpose:To explore the clinical and imaging features of nontuberculous mycobacteria(NTM)lung disease.Methods:Clinical and CT data of 57 patients with NTM lung discase confirmed by clinical and laboratory tests in our hospital were retrospectively analyzed.Results:①The age range with most patients was 40 to 79 years(45/57,78.95%).②The most common clinical symptoms were cough(47/57,82.46%),expectoration(45/57,78.95%),hemoptysis(25/57.43.86%),fever(23/57,40.35%)and chest tightness(17/57,29.82%).③The patients were often associated with pulmonary underlying diseases,such as COPD(6/57,10.53%),chronice pulmonary tuberculosis(6/57,10.53%),bronchiectasis(4/57,7.02%).④The most common MSCT findings were multiple lobular center nodules(42/57,73.68%),bronchiectasis(31/57,54.39%),and cavities(24/57,42.1%).⑤The distribution of nodules in the center of lobule had no character features,and bronchiectasis was mainly in the middle lobe of right lung(19/57.33.33%)and/or the lingular segment of left lung(14/57,24.56%).The cavity mostly appeard in the two upper lungs(right,11/57,19.30%;left,8/57,14.04%),and mostly near the peripheral subpleural area(18/57,31.58%).Conclusion:For elderly patients with underlying lung discases,MSCT images show mutiple lobular center nodules,right lobe and/or left sublingual segment bronchiectasis,and two upper lung parenchymal cavitics,the possibility of NTM lung disease should be considered.