成人初治继发性活动性肺结核痰菌培养结果与CT特征的关系分析

Analysis of relationship between sputum culture and CT characteristics of adults with primary treatment secondary active pulmonary tuberculosis

目的:对比成人初治继发性活动性肺结核痰菌阳性与阴性患者胸部CT特点的差异。方法:选择79例确诊的成人初治继发性活动性肺结核患者,根据痰菌培养结果分为痰菌阳性组38例和痰菌阴性组41例。所有患者均行胸部CT检查。以多因素logistic回归分析明确成人初治继发性活动性肺结核痰菌阳性的危险因素;以痰菌培养结果为金标准,分析CT诊断该病的效能。结果:痰菌阳性组树芽征、大结节、段性实变、磨玻璃样变、支气管扩张及空洞征象患者比例分别为81.58%、68.42%、23.68%、55.26%、28.95%、57.89%,均高于痰菌阴性组的53.66%、46.34%、7.32%、29.27%、9.76%、17.07%(均P<0.05)。经多因素logistic回归分析发现:树芽征、段性实变、空洞均是成人初治继发性活动性肺结核痰菌阳性的独立危险因素(均OR>1,均P<0.05)。以痰菌培养为金标准,胸部CT诊断成人初治继发性活动性肺结核痰菌阳性的敏感度、特异度及准确率分别为92.11%(35/38)、92.68%(38/41)、92.41%(73/79)。结论:成人初治继发性活动性肺结核痰菌阳性与痰菌阴性患者胸部CT特征存在明显差异,前者多见树芽征、大结节、段性实变、磨玻璃样变、支气管扩张及空洞征象。

Objective:To compare CT characteristics in the chest of adults with sputum bacilli-positive and sputum bacilli-negative secondary active pulmonary tuberculosis.Methods:Seventy-nine patients with newly treated secondary active pulmonary tuberculosis were included in the study.The patients were divided into a sputum-positive group(38 cases)and a sputum-negative group(41 cases)according to the results of sputum culture.Chest CT examination was performed on all patients.Multivariate logistic regression analysis was used to identify the risk factors for positive sputum bacteria in adults with secondary active pulmonary tuberculosis at initial treatment.In addition,the results of sputum culture were used as the gold standard to analyze the diagnostic efficacy of CT.Results:The proportions of tree bud sign,macronodules,segmental consolidation,ground glass change,bronchiectasis and cavity sign in the sputum-positive group were 81.58%,68.42%,23.68%,55.26%,28.95%,57.89%,respectively,which were higher than those in the sputum-negative group of 53.66%,46.34%,7.32%,29.27%,9.76%and 17.07%,respectively(all P<0.05).Multivariate logistic regression analysis showed that tree bud sign,segmental consolidation and cavity were independent risk factors for positive sputum bacteria in adults with primary treatment secondary active pulmonary tuberculosis(OR>1,P<0.05).Using sputum culture as the gold standard,the sensitivity,specificity and accuracy of chest CT in the diagnosis of positive sputum in adults with primary secondary active pulmonary tuberculosis were 92.11%(35/38),92.68%(38/41)and 92.41%(73/79),respectively.Conclusions:There are significant differences in the chest CT features of adult patients with primary secondary active pulmonary tuberculosis who are sputum mycelium positive and sputum mycelium negative.In the former patients,there are more tree bud signs,macronodules,segmental consolidation,ground glass lesions,bronchiectasis and cavity.