HRCT诊断活动性肺结核间质改变的价值观察  

Value of HRCT in the diagnosis of interstitial changes in active pulmonary tuberculosis

作　　者：刘树荣 孙培培 侯学静 王强 姜立杰 LIU Shu-rong;SUN Pei-pei;HOU Xue-jing;WANG Qiang;JIANG Li-jie(Department of Radiology,Hengshui People′s Hospital,Hengshui,Hebei 053000,China)

机构地区：[1]衡水市人民医院影像中心,河北衡水053000

出　　处：《临床肺科杂志》2021年第7期1057-1062,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的观察高分辨率CT(HRCT)诊断活动性肺结核间质改变的价值。方法选取2016年3月2019年5月哈励逊国际和平医院收治的活动性肺结核患者120例,均接受HRCT检查,依据是否存在肺间质改变分为研究组(存在间质病变)、对照组(不存在间质病变),分析肺间质病变发生特点、分布部位与特征,观察肺间质改变者治疗前后HRCT影像特征变化及与病灶吸收的关系。结果肺结核间质病变好发于两上肺野,且病变呈双肺弥漫性分布,主要为片状蔓延或沿支气管树分布,小叶内间质异常为间质改变的主要HRCT表现,包括小叶内细网织线影、微结节、磨玻璃影、树芽征等,依据间质类型分为轴心间质异常24.69%、周围间质异常40.74%、间隔间质异常34.57%,伴发实变影、支气管播散、气道增厚伴扩张、空洞、肺大疱、气胸;经规范抗结核治疗后30.86%病灶明显吸收,稍有吸收25.93%,无明显吸收43.21%,吸收组、未吸收组治疗中与治疗前各HRCT影像比较差异无统计学意义(P>0.05),而治疗结束时吸收组小叶内细网织线影、微结节、磨玻璃影、树芽征检出率明显低于治疗前及治疗中(P<0.05),吸收组小叶内细网织线影、微结节检出率低于未吸收组(P<0.05);相关性分析显示,活动性肺结核患者HRCT的小叶内细网织线影、微结节、磨玻璃影、树芽征与病灶吸收有明显负相关性(P<0.05)。结论活动性肺结核患者HRCT有一定影像学表现,以小叶内间质异常为主,表现为小叶内细网织线影、微结节、磨玻璃影、树芽征等,其中小叶内细网织线影、微结节,吸收慢,需更长时间治疗与观察。Objective To observe the value of high-resolution CT(HRCT) in the diagnosis of interstitial changes in active pulmonary tuberculosis. Methods A total of 120 patients with active pulmonary tuberculosis who were treated at Harrison International Peace Hospital from March 2016 to May 2019 were selected. All were subjected to HRCT. According to the presence or absence of interstitial lung changes, the subjects were divided into the study group(with interstitial lesions) and the control group(without interstitial lesions). Their occurrence characteristics, location and characteristics of interstitial lung lesions were analyzed. The relationship between changes of HRCT images before and after treatment and absorption of lesions in patients with interstitial lung changes was observed. Results Interstitial lesions of pulmonary tuberculosis mostly occurred in the upper lung fields. The lesions diffusely distributed in both lungs, mainly showing flake-like spread or distribution along the bronchial tree. Interstitial intralobular abnormalities were main HRCT findings of interstitial changes, including intralobular fine mesh line shadows, micro-nodules, ground-glass opacity, tree bud signs, etc. According to the interstitial type, abnormalities were divided into axial interstitial abnormalities(24.69%), peripheral interstitial abnormalities(40.74%), and septal interstitial abnormalities( 34. 57%),accompanied by consolidation shadows,bronchial dissemination,airway thickening and dilatation,cavitation,bullae of lung and pneumothorax. After standard anti-tuberculosis treatment,30.86% of the lesions were obviously absorbed,25. 93% were slightly absorbed,and 43. 21% were not significantly absorbed. There was no statistically significant difference in HRCT images between the absorption group and the non-absorption group during and before treatment( P > 0. 05). The detection rates of fine mesh line shadows,micro-nodules,ground-glass opacity and tree bud signs in the absorption group at the end of treatment were significantly lower

关 键 词：HRCT 活动性肺结核 间质改变 价值 

分 类 号：R521[医药卫生—内科学]