结核病治疗中发生矛盾反应的胸部CT分析  

Chest CT manifestations of tuberculous paradoxical reaction during the treatment

作　　者：尹阳 舒健[1] 熊域皎 邹丽华 YIN Yang;SHU Jian;XIONG Yujiao;ZOU Lihua(Department of Radiology,the Affiliated Hosptital of Southwest Medical University,Luzhou,Sichuan Province 646000,China;Department of Radiology,Lethan People's Hospital,Leshan,Sichuan Province 614000,China;Department of Infection,Leshan People's Hospital,Leshan,Sichuan Province 614000,China;Department of Ultrasound,the Affiliated Hosptital of Southwest Medical University,Luzhou,Sichuan Province 646000,China)

机构地区：[1]西南医科大学附属医院放射科,四川泸州646000 [2]乐山市人民医院放射科,四川乐山614000 [3]乐山市人民医院感染科,四川乐山614000 [4]西南医科大学附属医院超声科,四川泸州646000

出　　处：《实用放射学杂志》2022年第4期551-554,共4页Journal of Practical Radiology

摘　　要：目的分析结核病治疗中发生矛盾反应(PR)的胸部CT表现特征.方法回顾性分析35例结核病患者发生PR的临床及胸部CT资料,比较PR发生前后胸部CT表现变化情况.结果35例患者包括单纯继发型肺结核20例,继发型肺结核合并结核性胸膜炎(TP)15例.PR灶发现时间为抗结核治疗(ATT)后(3.1±1.6)个月,PR灶开始吸收时间为继续ATT后(3.4±2.2)个月.肺结核发生PR灶共30例,类型包括腺泡实变融合28例,肺段样实变5例,树芽征7例,分布包括原发灶及周围28例,同侧其他叶4例,对侧叶6例,且对侧叶均为树芽征;TP发生PR灶共15例,均为同侧胸膜及胸膜下结核瘤;另有5例PR灶表现为胸部增大淋巴结;胸腔积液增多3例;肺内空洞增大3例、新增3例,均为单一薄壁空洞;所有病例均无肺毁损改变;10例表现出PR灶反复发生及变化不同步,4例出现胸腺反弹.结论结核病发生PR灶的胸部CT表现以肺内原发灶及其周围腺泡实变融合灶增加、TP同侧新增胸膜及胸膜下结核瘤为主,亦可发生在非最初感染部位,具有自限性,可不同步变化或反复发生,胸腺反弹有一定提示作用.Objective To investigate the chest CT features of paradoxical reaction(PR)during the treatment of different types of tuberculosis.Methods The clinical and chest CT data of 35 patients with PR and tuberculosis diagnosed were analyzed retrospectively,and the changes of chest CT before and after PR were compared.Results The 35 patients included 20 cases of secondary pulmonary tuberculosis and other 15 cases of secondary pulmonary tuberculosis complicated with tuberculous pleurisy(TP).The time point at which the PR foci were found was(3.1±1.6)months after antituberculosis therapy(ATT),and the initial absorption time point of PR foci was(3.4±2.2)months after following ATT.The PR foci were found in a total of 30 patients with pulmonary tuberculosis,including acinar consolidation and fusion in 28 cases,segmental consolidation in 5 cases,and tree bud sign in 7 cases.Meanwhile,the locations of the PR foci included the primary focus and its surrounding region in 28 cases,ipsilateral other lobes in 4 cases,and contralateral lobes in 6 cases all with tree bud sign.The PR foci occurred in 15 cases with TP with ipsilateral pleural and subpleural tuberculomas.Enlarged chest lymph nodes were seen in other 5 cases with PR foci,and the pleural effusion was increased in 3 cases.Enlarged pulmonary cavity in 3 cases and new cavity in other 3 cases were also found,and all were single and thin-walled.No lung destruction was found in all cases.Recurrent PR foci and non-synchronous changes in 10 cases and thymus rebound hyperplasia in 4 cases were shown on CT images.Conclusion The chest CT features of tuberculous PR focus included growing and increasing primary focus and its surrounding acinar consolidation and fusion,a nd new pleural and subpleural tuberculomas on the ipsilateral side of TP,sometimes in non-initial infection sites.The PR focus,usually self-limited,can not change synchronously or occur repeatedly.The thymus rebound hyperplasia plays a certain suggestive role in the diagnosis.

关 键 词：结核病 矛盾反应 计算机体层成像 

分 类 号：R52[医药卫生—内科学] R814.42[医药卫生—临床医学]