多层螺旋CT在肺结核鉴别诊断中应用价值

Value of multilayer spiral CT in the differential diagnosis of pulmonary tuberculosis

目的探讨多层螺旋CT在临床鉴别诊断肺结核中的临床价值。方法选取2021年1月至2022年12月江西省鹰潭市余江区人民医院收治的80例疑似肺结核患者,均行常规X线检查、多层螺旋CT,并以痰培养为金标准,统计2种方法肺结核检出率,比较2种方法空洞、磨玻璃密度影、腺泡结节检出率;以痰培养为金标准,分析2种方法诊断肺结核的效能;采用Kappa检验验证常规X线检查、多层螺旋CT诊断肺结核与金标准的一致性。结果80例疑似患者经痰培养检出62例,常规X线检出56例,检出率为90%(56/62);多层螺旋CT检出61例,检出率为98%(61/62);多层螺旋CT检出空洞、磨玻璃密度影、腺泡结节率为69%、75%、72%,高于常规X线检查的52%、59%、56%,差异有统计学意义(P<0.05);多层螺旋CT诊断肺结核的敏感度、准确度为97%、96%,高于常规X线检查的87%、88%,差异有统计学意义(P<0.05);Kappa检验显示,常规X线检查诊断肺结核与金标准一致性尚可(Kappa=0.679,P<0.01);结核抗体与痰培养一致性极好(Kappa=0.895,P<0.01)。结论多层螺旋CT在鉴别诊断肺结核中具有较高价值,可提高诊断敏感度、准确度,减少漏诊、误诊风险,便于尽早开展肺结核防治工作。

Objective To investigate the clinical value of multilayer spiral CT in clinical differential diagnosis of pulmonary tuberculosis.Methods Eighty patients with suspected tuberculosis admitted to Yujiang District People's Hospital from January 2021 to December 2022 were selected as the study subjects,all of them underwent conventional X-ray examination and multilayer spiral CT,and sputum culture was used as the gold standard to count the detection rate of tuberculosis of the two methods,and to compare the detection rate of cavities,ground-glass density shadows,and glandular vesicular nodules of the two methods.The efficacy of the two methods in diagnosing tuberculosis of the two methods was analyzed by using sputum culture as the gold standard,and the consistency of the diagnosis of tuberculosis of the two methods with that of the gold standard was validated by the kappa test for the conventional X-ray examination and multilayer spiral CT.Results Sixty-two of 80 suspected patients were detected by sputum culture,and 56 cases were detected by the conventional X-ray,with a detection rate of 90%(56/62);61 cases were detected by multilayer spiral CT,with a detection rate of 98%(61/62).The rates of cavity,ground glass density shadow,and acinar nodules were 69%,75%,72%,which were higher than the 52%,59%,56%of the conventional X-ray examination,the difference was statistically significant(P<0.05).The sensitivity and accuracy of multilayer spiral CT in diagnosing pulmonary tuberculosis were 96.77%,96%,which were higher than 87%and 88%of the conventional X-ray examination,and there was a statistical significant difference(P<0.05).The kappa test showed that routine X-ray examination for the diagnosis of tuberculosis was still consistent with the gold standard;the consistency between tuberculosis antibody and sputum culture was excellent.Conclusion Multilayer spiral CT has high value in the differential diagnosis of pulmonary tuberculosis,which can improve diagnostic sensitivity and accuracy,reduce the risk of leakage and misdiagnosis,and facilitate the early prevention and treatment of tuberculosis.