非结核分枝杆菌肺病的CT表现及与肺结核的鉴别诊断  

CT findings of non-tuberculous mycobacteria pulmonary disease and the differential diagnosis with tuberculosis

作　　者：李瀛[1] 王莉[1] LI Ying;WANG Li(Department of Radiology,Tianjin Haihe Hospital,Tianjin Institute of Respiratory Diseases,TCM Key Research Laboratory for Infectious Disease Prevention for State Asministration of Traditional Chinese Medicine,Tianjin 300350,China)

机构地区：[1]天津市海河医院放射科、天津市呼吸疾病研究所、国家中医药管理局中医药防治传染病重点研究室,天津300350

出　　处：《实用放射学杂志》2024年第3期365-369,共5页Journal of Practical Radiology

摘　　要：目的探讨非结核分枝杆菌(NTM)肺病的CT影像特点及与肺结核(TB)的影像差异.方法回顾性分析经菌群鉴定或支气管镜病理活检确诊的46例NTM肺病(NTM肺病组)及随机抽取确诊的64例TB患者(TB组)的影像资料.结果NTM肺病组平均年龄大于TB组(t=2.561,P<0.05).临床表现TB组咳嗽、咳痰多于NTM肺病组,NTM肺病组伴有肺基础病多于TB组(P<0.05).影像表现NTM肺病组支气管扩张、胸膜下薄壁空洞、实变(≥3 cm)伴支气管扩张多于TB组(P<0.05),TB组小叶中心结节、大结节(≥0.8 cm)、纵隔/肺门淋巴结肿大多于NTM肺病组(P<0.05).多因素二元logistic回归分析,支气管扩张、胸膜下薄壁空洞是NTM肺病的独立危险因素(P<0.05);大结节(≥0.8 cm)是TB的危险因素(P<0.05).结论支气管扩张、胸膜下薄壁空洞、实变(≥3 cm)伴支气管扩张是NTM肺病特征性的CT表现,对NTM肺病的诊断有重要的临床意义.Objective To explore the CT imaging characteristics of non-tuberculous mycobacteria(NTM)pulmonary disease and image differences from tuberculosis(TB).Methods The imaging data of 46 with NTM pulmonary disease(NTM pulmonary disease group)and 64 with TB(TB group)confirmed by flora identification or transbronchial biopsy were analyzed retrospectively.Results The mean age of NTM pulmonary disease group was greater than that of TB group(t=2.561,P<0.05).Clinical manifestations:TB group had more cough and expectoration than NTM pulmonary disease group,and yet NTM pulmonary disease group had more basic lung diseases than TB group(P<0.05).Imaging manifestations:bronchiectasis,subpleural thin-walled cavity,and consolidation(≥3 cm)with bronchiectasis were more common in NTM pulmonary disease group than TB group(P<0.05).In TB group,centrilobular nod-ules,large nodules(≥0.8 cm),and mediastinal/hilus of lung lymph node enlargement were more common than in NTM pulmonary dis-ease group(P<0.05).In multivariate binary logistic regression analysis,bronchiectasis,and subpleural thin-walled cavity were independent risk factors for NTM pulmonary disease(P<0.05),and large nodules(≥0.8 cm)was risk factor for TB(P<0.05).Conclusion Bronchiectasis,subpleural thin-walled cavity,and consolidation(≥3 cm)with bronchiectasis are the characteristic CT manifesta-tions of NTM pulmonary disease,which has important clinical significance for the diagnosis of NTM pulmonary disease.

关 键 词：非结核分枝杆菌肺病 肺结核 计算机体层成像 

分 类 号：R521[医药卫生—内科学] R814.42[医药卫生—临床医学]