活动性肺结核抗结核治疗后的HRCT影像动态分析及残余病变的临床意义  

Serial HRCT images of active pulmonary tuberculosis after treatment and the clinical significance of the residual lesions

作　　者：贺伟[1] 李成海[1] 谢汝明[2] 王岳[1] 周震[1] 宁锋钢[1] 周新华[1] 吕岩[1] 

机构地区：[1]首都医科大学附属北京胸科医院放射科,北京101149 [2]首都医科大学附属北京地坛医院放射科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第6期38-42,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都卫生发展科研专项资助项目(No.2011-2016-01)

摘　　要：目的探讨活动性肺结核抗结核治疗前及治疗后}tRCT征象的变化特点以及停药后残余病变的临床意义。方法对142例活动性肺结核病例进行前瞻性研究,观察活动性肺结核的CT征象转归表现及残余病变的影像变化。结果活动性肺结核活动性CT征象中边缘模糊小叶中心结节影、树芽征、磨玻璃阴影、小叶样实变影、支气管壁增厚、叶段性肺实变、亚段性肺实变、空洞和肿块较前显著减少、缩小,治疗前后检出率可见差异具有统计学意义（χ^2=150.0、130.5、99.6、202.8、50.9、11.4、38.9、74.5和5.6,JD均〈0.05）。非活动性病变纤维性病变及支气管扩张显著增加,治疗前后检出率差异具有统计学意义（χ^2=30.9、3.9,P均〈0.05）;49例（34.5%）患者残余活动性病变,停药后随访12-15个月,46.9%（23/49）患者病变继续好转缩小或消失,仅1例复发。结论HRCT检查有助于活动性肺结核治疗疗效的判定,疗程结束时立即对肺结核活动性进行判定存在一定偏差;残留的活动性病变不能预测活动性病变的持续存在和早期复发的可能性。Objective To explore the HRCT changes of active pulmonary tuberculosis（PTB）before and after anti-tuberculosis treatment,and to evaluate the clinical significance of residual lesions in chest computed tomography（CT） findings at the end of anti-tuberculosis treatment.Methods The serial CT manifestations in 142 patients with active pulmonary tuberculosis were analyzed,prospectively.While the image changes in residual lesions were observed.Results Among the CT signs of active pulmonary tuberculosis,there were significant differences in the centrilobular nodule,tree-in bud,ground glass opacity,lobular consolidation,bronchial wall thickness,lobar and segmental pulmonary consolidation,subsegmental pulmonary consolidation,cavity and mass before and after treatment（χ^2 = 150.0,130.5,99.6,202.8,50.9,11.4,38.9,74.5 and 5.6,respectively;P all 〈0.05）.There were significant differences in the bronchiectasis,fiber lesions before and after treatment（χ^2 = 30.9,3.9;P all 〈0.05）.The residual lesions in 49 patients were observed with 12-15 months follow-up.There were 46.9%（23/49） patients whose active lesions sequentially shrunk or dissipated,but only one case recurred.Conclusions HRCT was helpful to appraise the effect of active PTB changes.There was limitations in judging tuberculosis activity with CT immediately after treatment.Residual active lesions cannot predict the persistent activity or the possibility of early relapse of PTB.

关 键 词：结核 肺 活动性 X线计算机 体层摄影术 高分辨率 

分 类 号：R521[医药卫生—内科学]