高分辨率CT对尘肺合并肺结核诊断的价值研究

Study on the value of high-resolution CT in diagnosis of pneumoconiosis combined with pulmonary tuberculosis

目的:探讨高分辨率X射线计算机断层扫描(CT)在尘肺合并肺结核诊断中的应用价值。方法:选取医院呼吸内科收治的24例尘肺和88例尘肺合并肺结核患者的临床资料,分别采用X射线、高分辨率CT对所有患者进行检查,比较两种检查方法对尘肺合并肺结核分期的诊断结果,以及肺结核类型在Ⅰ~Ⅱ和Ⅲ期尘肺患者中的发生频率,高分辨率CT检查尘肺合并肺结核与尘肺患者受累淋巴结的强化类型,观察不同临床分期尘肺合并肺结核患者高分辨率CT表现。结果:高分辨率CT对尘肺合并肺结核分期的检出率为71.59%,显著高于X射线诊断(30.68%),差异有统计学意义(χ^(2)=32.886,P<0.05)。Ⅲ期尘肺合并肺结核患者尘肺结核团块型发生率为52.38%,显著高于Ⅰ~Ⅱ期,差异有统计学意义(χ^(2)=17.995,P<0.05)。尘肺合并肺结核患者的高分辨率CT检查环状强化、多房样征占比显著高于尘肺患者,均匀强化占比显著低于尘肺患者,差异有统计学意义(χ^(2)=43.826,χ^(2)=6.217,χ^(2)=30.475;P<0.05)。尘肺合并肺结核患者Ⅰ~Ⅱ期CT表现为大片状、厚壁、树芽征、胸膜增厚、纵膈淋巴结肿大及伴钙化占比显著低于Ⅲ期患者,差异有统计学意义(χ^(2)=10.761,χ^(2)=17.617,χ^(2)=16.808,χ^(2)=43.843,χ^(2)=5.187,χ^(2)=13.964;P<0.05),Ⅰ~Ⅱ期尘肺合并肺结核患者CT表现为薄壁的患者占比为40.00%,显著高于Ⅲ期患者(14.29%),差异有统计学意义(χ^(2)=6.991,P<0.05)。结论:高分辨率CT对尘肺合并肺结核分期的诊断价值高于X射线。Ⅲ期尘肺合并肺结核患者主要肺结核类型为尘肺结核团块型,CT表现为大片状、厚壁、树芽征、胸膜增厚、纵隔淋巴结肿大且伴钙化,Ⅰ~Ⅱ期尘肺合并肺结核患者则主要表现为薄壁。

Objective:To explore the application value of high resolution X-ray computed tomography(CT) in the diagnosis of pneumoconiosis complicated with pulmonary tuberculosis.Methods:The clinical data of 24 patients with pneumoconiosis and 88 patients with pneumoconiosis combined with pulmonary tuberculosis who admitted to the department of respiratory medicine of hospital were selected.And X-ray and high-resolution CT were respectively adopted to implement examination for all patients.The diagnostic results of the staging of pneumoconiosis combined with pulmonary tuberculosis between two kinds of examination methods were compared,as well as the occurrence frequency of the type of pulmonary tuberculosis in patients with pneumoconiosis at Ⅰ-Ⅱ and Ⅲ stage,and the intensity type of the involved lymph gland of the two kinds of patients by the examination of high-resolution CT.And then,the high-resolution CT appearances of patients with pneumoconiosis combined with pulmonary tuberculosis at differently clinical staging were further observed.Results:The detection rate of high-resolution CT was 71.59% for the staging of pneumoconiosis combined with pulmonary tuberculosis,which was significantly higher than that of X-ray(30.68%),and the difference of that between two methods was statistically significant(χ^(2)=32.886,P<0.05).The incidence rate of the type of tuberculosis mass of pneumoconiosis of patients with pneumoconiosis combined with pulmonary tuberculosis at stage Ⅲ was 52.38%,which was significantly higher than that in stage Ⅰ-Ⅱ(χ^(2)=17.995,P<0.05).The ratios of circular enhancement and multilocular sign of high-resolution CT examination of patients with pneumoconiosis combined with pulmonary tuberculosis were respectively significantly higher than those of patients with pneumoconiosis(χ^(2)=43.826,χ^(2)=6.217,P<0.05),while the difference of the ratio of uniform enhancement of them was significantly lower than that of patients with pneumoconiosis(χ^(2)=30.475,P<0.05).The ratios of large flake,thick wall,tree bud sign,pleural thickening,enlargement of mediastinal lymph node and accompaniment with calcification in CT appearance of patients with pneumoconiosis combined with pulmonary tuberculosis at stage Ⅰ-Ⅱ were significantly lower than those of those at stage Ⅲ(χ^(2)=10.761,χ^(2)=17.617,χ^(2)=16.808,χ^(2)=43.843,χ^(2)=5.187,χ^(2)=13.964,P<0.05).In addition,the ratio of thin wall in the CT appearance of patients with pneumoconiosis combined with pulmonary tuberculosis at stage Ⅰ-Ⅱ was 40.00%,which was significantly higher than that of patients at stage Ⅲ(14.29%,χ^(2)=6.991,P<0.05).Conclusion:The diagnostic value of high –resolution CT was higher than that of X-ray for the staging of patients with pneumoconiosis combined with pulmonary tuberculosis.The main type of pulmonary tuberculosis in patients with pneumoconiosis combined with pulmonary tuberculosis at stage Ⅲ is mass type of pneumoconiosis tuberculosis,which is large flake,thick wall,tree bud sign,pleural thickening,enlargement of mediastinal lymph node and accompaniment with calcification in CT appearance,and the main appearance of patients with pneumoconiosis combined with pulmonary tuberculosis at stage Ⅰ-Ⅱ is thin wall.