《耐药肺结核影像学诊断专家共识》解读

Interpretation of Expert consensus imaging diagnosis of drug-resistant pulmonary tuberculosis

耐药肺结核由于其诊断和治疗困难、病死率较高的特点,被WHO认定是结核病防控中的三大挑战之一,亦是重大公共卫生问题。为此,中国研究型医院学会感染与炎症放射学专业委员会等机构,组织40多位从事耐药肺结核基础研究及临床相关专家,编写了《耐药肺结核影像学诊断专家共识》。该共识基于循证医学证据等级评估并参照证据质量和推荐强度分级共识指导原则,推荐了耐药肺结核影像学检查优选(推荐意见1~5),指出胸部X线摄影可作为耐药肺结核的首选筛查方法(证据级别:Ⅲ,推荐强度:强)和疗效评估的常用手段(证据级别:Ⅳ,推荐强度:强);CT可作为诊断耐药肺结核的主要手段(证据级别:Ⅳ,推荐强度:强);依据耐药肺结核影像学诊断相关研究的文献资料,阐述了耐药肺结核的CT影像学表现,包括单耐药肺结核(含利福平耐药肺结核)(mono-resistant/rifampicin-resistant pulmonary tuberculosis,MR/RR-PTB)、耐多药肺结核(multidrug-resistant pulmonary tuberculosis,MDR-PTB)[含多耐药肺结核(polydrug-resistant pulmonary tuberculosis,PDR-PTB)]、广泛耐药肺结核(extensively drug-resistant pulmonary tuberculosis,XDR-PTB)[含准广泛耐药肺结核(pre-extensively drug resistant pulmonary tuberculosis,pre-XDR-PTB)]患者的影像表现与特征(推荐意见6~12);同时比较了耐药肺结核与非结核分枝杆菌肺病、肺曲霉病和肺隐球菌病等非结核肺病的影像学鉴别要点,为耐药肺结核的临床影像学精准诊断及指导治疗提供了依据。本文对《耐药肺结核影像学诊断专家共识》进行解读,以期有助于临床医生对耐药肺结核的诊断。

Due to its difficulties in diagnosis and treatment and high case fatality rate,drug-resistant pulmonary tuberculosis is identified by the WHO as one of the three major challenges in tuberculosis prevention and control,and it is also a major public health problem..To this end,the Chinese Professional Committee of Infection and Inflammation Radiology and other institutions,organized more than 40 influential experts at home and abroad engaged in basic research and clinical related of drug-resistant tuberculosis,the Expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis was compiled.Expert consensus on imaging diagnosis of drug-resistant tuberculosis is based on the assessment of evidence-based medicine and referring to the graded consensus guidelines on evidence quality and recommendation strength.Recommendation of imaging examination for drug-resistant tuberculosis (recommendation 1-5),including chest X-ray (DR) as the preferred screening method for drug-resistant pulmonary tuberculosis (level of evidence:Ⅲ,strength of recommendation:strong),and a common means of efficacy evaluation (level of evidence:Ⅳ,strength of recommendation:strong).CT is the main means of diagnosis of drug-resistant pulmonary tuberculosis (level of evidence:Ⅳ,strength of recommendation:strong).Based on the analysis of the imaging data of drug-resistant pulmonary tuberculosis,the CT imaging findings of drug-resistant pulmonary tuberculosis were described,including expert consensus indicating the main manifestations and characteristics of single drug resistance (including rifampin resistance),multidrug-resistant pulmonary tuberculosis (MDR-PTB)[including polydrug-resistant pulmonary tuberculosis (PDR-PTB)],and extensive drug-resistant pulmonary tuberculosis(including pre-extensive drug-resistant pulmonary tuberculosis) (recommendations 6-12).At the same time,the expert consensus described the key points of imaging differentiation between drug-resistant pulmonary tuberculosis and non-tuberculosis pulmonary disease,pulmonary aspergillosis and pulmonary cryptococcal disease.It provides a basis for the accurate diagnosis and guidance of clinical imaging of drug-resistant tuberculosis.This article interprets the expert consensus on imaging diagnosis of drug-resistant tuberculosis in order to help clinicians diagnose drug-resistant tuberculosis.