耐药肺结核伴空洞患者的CT表现特征分析

Analysis of CT features of drug-resistant pulmonary tuberculosis with cavity

目的探讨耐药肺结核伴空洞患者的CT表现特征,以期提高对耐药肺结核伴空洞的诊断水平。方法回顾性分析广州市胸科医院2018年1月至2019年12月经比例法药物敏感性试验确诊的56例耐药肺结核伴空洞患者(A组),同时收集同期符合纳入标准的药物敏感肺结核伴空洞患者56例(B组)进行对比分析,匹配原则为性别相同、年龄±2岁。通过对两组患者CT扫描征象的对比,分析耐药肺结核伴空洞的CT表现特征。结果 A组空洞数量≥3个、空洞在肺叶分布≥3叶的检出率分别为55.36%(31/56)、46.43%(26/56),B组分别为32.14%(18/56)、26.79%(15/56),两组比较差异均有统计学意义(χ^(2)值分别为6.132、4.655,P值分别为0.013、0.031)。A组厚壁空洞、毁损肺的检出率分别为61.44%(94/153)、32.14%(18/56),B组分别为49.21%(62/126)、14.29%(8/56),两组比较差异均有统计学意义(χ^(2)值分别为4.194、5.009,P值分别为0.041、0.025)。A组薄壁空洞、引流支气管、"树芽征"的检出率分别为14.38%(22/153)、28.10%(43/153)、32.14%(18/56),B组分别为30.16%(38/126)、40.48%(51/126)、51.79%(29/56),两组比较差异均有统计学意义(χ^(2)值分别为10.192、4.734、4.436,P值分别0.001、0.030、0.035)。结论耐药肺结核伴空洞患者CT扫描更易检出空洞数量≥3个、空洞在肺叶分布≥3叶、厚壁空洞、毁损肺;药物敏感肺结核伴空洞患者CT扫描更易检出薄壁空洞、引流支气管、"树芽征";两者有各自的CT表现特点,可为临床早期诊断与治疗提供帮助。

Objective To explore the CT features of drug-resistant tuberculosis(DR-TB)patients with cavity,in order to improve diagnosis for DR-TB with cavity. Methods A retrospective analysis of 56 cases of pulmonary DR-TB with cavity(group A)confirmed by drug susceptibility test(proportional method)in Guangzhou Chest Hospital from January 2018 to December 2019.At the same time,56 cases of drug-sensitive pulmonary tuberculosis with cavity(group B)were collected for comparative analysis,matching each Group A patient with the same gender and age±2 years.By comparing CT scanning findings of the two groups,we analyzed the CT features of DR-TB with cavity. Results In group A,the detection rates of number of cavities≥3,cavities located in≥3 lung lobes were 55.36%(31/56)and 46.43%(26/56)respectively.In group B,they were 32.14%(18/56)and26.79%(15/56)respectively.The differences between the two groups were statistically significant(χ^(2)=6.132 and4.655,P=0.013 and 0.031,respectively).In group A,the detection rates of thick wall cavity and destroyed lungs were 61.44%(94/153)and 32.14%(18/56)respectively,while in group B,they were 49.21%(62/126)and14.29%(8/56)respectively.The differences between the two groups were statistically significant(χ^(2)=4.194 and5.009,P=0.041 and 0.025,respectively).The detection rates of thin-walled cavity,drainage bronchus and tree bud sign in group B were 30.16%(38/126),40.48%(51/126),51.79%(29/56)respectively.In group A,they were 14.38%(22/153),28.10%(43/153),32.14%(18/56)respectively.There were significant differences between the two groups(χ^(2)=10.192,4.734,4.436,P=0.001,0.030,0.035,respectively). Conclusion The CT scan of DR-TB with cavity is more likely to have number of cavities≥3,cavities located in≥3 lung lobes,thick wall cavity and destroyed lung.The CT scan of drug-sensitive pulmonary tuberculosis with cavity is more likely to show thin-walled cavity,drainage bronchus and tree bud sign.They have their own CT features which can provide help for early clinical diagnosis and treatment.