早期无症状活动性肺结核的CT影像学分析

CT imaging analysis of early asymptomatic active pulmonary tuberculosis

目的探析早期无症状活动性肺结核(APT)的CT特征与治疗转归。方法回顾性评估陕西省富平县医院2022年-2023年参与肺结核筛查并经临床诊断为活动性肺结核的160例病人的资料,于其治疗前、后对CT整体表现展开对比分析。结果160例早期无症状活动性肺结核中,156例肺部CT特征为肺实质性病损,4例显示为胸腔积液,共201个肺叶发生病变,其中,上叶病灶121个,下叶病灶76个,中叶病灶4个;CT异常表现中,108例出现了树芽征(占67.5%),143例出现了微结节(占89.4%),34例出现了肺实变(占21.3%),抗结核治疗后病灶一定程度被吸收改善,部分CT异常现象与治疗前相比存在统计学差别(P<0.05)。结论对于无症状表现,但肺部CT检查可见肺内微结节或树芽征时,尤其是有明确结核暴露史者,要首先考虑到活动性肺结核。

Objective To explore the CT characteristics and treatment outcomes of early asymptomatic active pulmonary tuberculosis(APT).Methods CT imaging data of 160 patients who participated in pulmonary tuberculosis screening and were clinically diagnosed as active pulmonary tuberculosis in our hospital from 2022 to 2023 were retrospectively evaluated,and the overall CT findings were compared before and after treatment.Results Among the 160 cases of early asymptomatic active pulmonary tuberculosis,156 cases showed substantial lung lesion and 4 cases showed pleural effusion.A total of 201 lung lobe lesions occurred,including 121 lesions in the upper lobe,76 lesions in the lower lobe and 4 lesions in the middle lobe.Among the abnormal CT findings,108 cases had tree bud signs(67.5%),143 cases had micronodules(89.4%),and 34 cases had lung consolidation(21.3%).The absorption of the lesions was controlled to a certain extent after anti-tuberculosis treatment,and there were statistical differences between some abnormal CT findings and those before treatment(P<0.05).Conclusion Active pulmonary tuberculosis should be considered first when asymptomatic manifestations but pulmonary micronodules or tree bud signs can be seen on CT examination,especially in patients with a clear history of tuberculosis exposure.