非结核分枝杆菌肺病与继发性肺结核的多层螺旋CT征象对比分析

Comparative Research of Multi-Slice CT in the Diagnosis of Non-Tuberculosis Mycobacteria Pulmonary Disease and Pulmonary Tuberculosis

目的对比分析非结核分枝杆菌(NTM)肺病与继发性肺结核的多层螺旋CT(MSCT)表现特征,以提高对两者的鉴别诊断能力。方法回顾性分析经临床及实验室检查确诊的60例NTM肺病(A组)和100例继发性肺结核(B组)患者的一般资料及MSCT图像,采用t检验、Mann-Whitney U检验、χ~2检验或Fisher确切概率法进行统计分析,P<0.05为差异有统计学意义。结果两组患者男女性别差异有统计学意义(P=0.01,χ~2=10.301)。A组平均发病年龄高于B组(P=0.000,t=-4.324)。A组病灶主分布于右上叶、下叶(各47例)及右中叶(45例),B组病灶主分布于右上叶(67例)、左上叶(53例)及右下叶(47例),差异有统计学意义(P=0.000,χ~2=28.125)。A组病灶的CT主要征象为支气管扩张(73.3%)、细支气管炎(65.0%)及空洞(40.0%),B组病灶的CT主要征象为支气管扩张(51.0%)、空洞(35.0%)及胸膜炎(20.0%),差异有统计学意义(P=0.000,χ~2=26.679)。两组病例空洞数量无明显差异(P=0.297,χ~2=1.090)。空洞形态无明显差异(P=0.322,χ~2=2.268),空洞位置差异有统计学意义[外带:中内带(P=0.000,χ~2=35.694)。A组空洞伴卫星灶的比例(36.7%)明显低于B组(94%),差异有统计学意义(P=0.000,χ~2=61.827)。两组病例支气管扩张分布位置差异有统计学意义(P=0.383,χ~2=5.275),A组病灶主分布于右中叶(30例)、左上叶舌段(27例),B组病灶主分布于左上叶(33例)及右上叶(30例)。A组支气管扩张均为柱状,B组支气管扩张呈多形态。结论 NTM肺病与继发性肺结核的性别、年龄、病灶分布位置、空洞位置、伴卫星病灶征象及支气管扩张位置、形态征象有差异,MSCT对两者的鉴别诊断是有价值的。

Objective To compare and analyze the multi-slice spiral CT(MSCT)features of nontuberculous mycobacterial lung disease(NTM lung disease)and secondary pulmonary tuberculosis.Methods The general data and MSCT images of 60 patients with NTM lung disease(group A)and 100 patients with secondary pulmonary tuberculosis(group B)diagnosed by clinical and laboratory examinations were retrospectively analyzed by t test and Mann-Whitney U tests.Statistical analysis was performed byχ~2 test or Fisher exact probability method.P<0.05 was considered statistically significant.Results There was a statistically significant difference in gender between the two groups(P=0.01,χ~2=10.301).The mean age of onset in group A was higher than that in group B(P=0.000,t=-4.324).The lesions in group A were mainly distributed in the right upper lobe,lower lobe(47 cases)and right middle lobe(45 cases).The lesions in group B were mainly distributed in the right upper lobe(67 cases),the left upper lobe(53 cases)and the lower right lobe(47 cases).),the difference was statistically significant(P=0.000,χ~2=28.125).The main signs of CT in group A lesions were bronchiectasis(73.3%),bronchiolitis(65.0%)and cavities(40.0%).The main signs of CT in group B lesions were bronchiectasis(51.0%)and cavities(35.0%).There was a statistically significant difference in pleurisy(20.0%)(P=0.000,χ~2=26.679).There was no significant difference in the number of voids between the two groups(P=0.297,χ~2=1.090).There was no significant difference in void morphology(P=0.322,χ~2=2.268).The difference in the position of the cavity was statistically significant[outer band:mid-inner band(P=0.000,χ~2=35.694).The proportion of group A with satellites(36.7%)was significantly lower than that of group B(94%),and the difference was statistically significant(P=0.000,χ~2=61.827).There were significant differences in the location of bronchiectasis between the two groups(P=0.383,χ~2=5.275).The lesions in group A were mainly distributed in the right middle lobe(30 cases)and the left upper lobe(27 cases).Group B lesions were mainly distributed in the left upper lobe(33 cases)and the upper right lobe(30 cases).The bronchiectasis in group A was columnar,and the bronchiectasis in group B was polymorphous.Conclusion The gender,age,lesion location,cavity location,satellite lesion signs,bronchiectasis location and morphological signs of NTM pulmonary disease and secondary pulmonary tuberculosis are different.MSCT is valuable for differential diagnosis.