异基因造血干细胞移植后肺结核的影像学特点

Imaging of Pulmonary Tuberculosis after Allogenic Hematopoietic Stem Cell Transplantation

目的总结异基因造血干细胞移植(allo-HSCT)后肺结核(TB)的影像学特点,并比较其与普通人群肺TB影像的异同。方法回顾性分析8例allo-HSCT后确诊肺TB的胸片、胸部CT影像学资料,并在同期确诊肺TB的非移植患者中,随机进行1∶5配对,共选取40例患者进行比较。结果移植后肺TB在胸片上主要表现为实变和/或磨玻璃影(50%)、结节(33.3%)、纵隔淋巴结肿大(16.7%)。与非移植组比较,其磨玻璃影较多(33.3%vs 0%,P=0.002),病灶呈双侧分布者较多(66.7%vs 14.3%,P=0.016)。移植组首次胸部CT主要表现为实变和/或磨玻璃影(50%)、单发结节(25%)、弥漫"树芽征"(12.5%)及纵隔淋巴结肿大(12.5%),最常见的伴随征象为支气管气相(62.5%)。与非移植组比较,其磨玻璃影(50%vs 10%,P=0.006)、支气管气相(62.5%vs 25%,P=0.014)及网格影(25%vs 2.5%,P=0.016)较多,支气管受累(12.5%vs 77.5%,P<0.001)、"树芽征"(37.5%vs 77.5%,P=0.023)及索条影(0%vs 40%,P=0.028)较少。病灶在各段的分布比例较非移植组高(50%vs 20%,P<0.001)。随访CT中,上述三种较少的征象均明显增多,与非移植组的统计学差异消失。结论 allo-HSCT后肺TB的早期影像学表现与普通人群比较,磨玻璃影更多,缺乏典型征象,病灶分布更广,随访胸部CT中支气管受累、"树芽征"等典型征象明显增多。

Objective To summarize the imaging characteristics of pulmonary tuberculosis(PTB) after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to compare the difference and relationship with PTB in the general population. Methods The chest X-ray plain film and CT imaging data of 8 patients with confirmed PTB after allo-HSCT were analyzed retrospectively.Among the non-transplant patients who were confirmed PTB at the same time, 40 patients were selected in comparison with 1:5 random pairing. Results The main manifestations of PTB were consolidation and/or ground-glass opacity(GGO)(50%),nodules(33.3%) and mediastinal lymphadenopathy(16.7%).Compared with the non-HSCT group, there were more GGO(33.3% vs 0%,P= 0.002),and more lesions distributed bilaterally(66.7% vs 14.3%,P= 0.016).In the HSCT group, the first chest CT manifestations were consolidation and/or GGO(50%),single nodule(25%),diffuse tree-in-bud pattern(12.5%) and mediastinal lymphadenopathy(12.5%).The most common accompanying sign wasair bronchogram(62.5%).Compared with the non-HSCT group, there were more GGO(50% vs 10%,P= 0.006),air bronchogram(62.5% vs 25%,P= 0.014),reticular pattern(25% vs 2.5%,P= 0.016),and less bronchial involvement(12.5% vs 77.5%,P< 0.001),tree-in-bud pattern(37.5% vs 77.5%,P= 0.023) and linearsign(0% vs 40%,P= 0.028).The distribution ratio of lesions in each segment was higher than that in the non-HSCT group(50% vs 20%,P< 0.001).Inthe follow-up CT,the above three less signs were significantly increased, and the statistical difference between the two groups disappeared. Conclusion Compared with the general population, there were more GGO,lack of the typical signs and more diffuse distribution in PTB after allo-HSCT.The typical signs of bronchial involvement and tree-in-bud pattern increased significantly in follow-up chest CT.