胸部CT特征用于慢阻肺合并活动性肺结核临床诊断的价值  

Clinical Diagnostic Value of Chest CT Characteristics in COPD Combined with Active Pulmonary Tuberculosis

作　　者：李晓阳[1] 刘亚飞[2] 王霞[1] LI Xiao-yang;LIU Ya-fei;WANG Xia(The fourth Ward,Department of Tuberculosis Internal Medicine,The First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan Province,China;Department of Gastrointestinal and Bariatric Surgery,The First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院结核内科四病区 [2]新乡医学院第一附属医院胃肠与减重外科,河南新乡453100

出　　处：《中国CT和MRI杂志》2024年第11期56-58,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨慢阻肺合并活动性肺结核的胸部CT影像学特征及其临床诊断价值。方法回顾分析2021年1月至2023年1月收治65例疑似肺结核的慢阻肺患者影像学资料,以活动性肺结核的临床诊断结果(病原学、病理学)为“金标准”,比较分析慢阻肺合并活动性肺结核胸部X线、CT检查影像学表现、病变结果和诊断效能。结果65例慢阻肺患者中确诊活动性肺结核47例。CT检查结果显示肺气肿、气胸、病灶内钙化和支气管透亮影的表现率分别为15.38%、18.46%、20.00%和24.62%,均高于胸部X线的4.62%、6.150%、7.69%和10.77%(P<0.05)。胸部CT检查结果中慢阻肺合并活动性肺结核46例,胸部X线检查慢阻肺合并活动性肺结核39例。胸部CT检查特异度、阳性预测值和阴性预测值分别为94.44%、97.83%和89.47%,与胸部X线检查(分别为94.44%、97.44%和65.38%)比较差异无统计学意义(P>0.05);CT检查的灵敏度、准确率分别为95.74%、95.38%,均高于胸部X线检查的80.85%、84.62%(χ^(2)=5.045、4.188,P=0.025、0.041),CT检查、胸部X线检查的Kappa值分别为0.887、0.662。结论胸部CT检查对慢阻肺合并活动性肺结核诊断灵敏度、准确率优于胸部X线,且与临床诊断的一致性更高。Objective To explore imaging characteristics and clinical diagnostic value of chest CT in chronic obstructive pulmonary disease(COPD)combined with active pulmonary tuberculosis.Methods A retrospective analysis was performed on the imaging data of 65 patients with COPD and suspected pulmonary tuberculosis between January 2021 and January 2023.Taking clinical diagnosis results(etiology,pathology)of active pulmonary tuberculosis as the golden standard,imaging findings of chest X-ray and CT,pathological results and their diagnostic efficiency for COPD combined with active pulmonary tuberculosis were compared and analyzed.Results In the 65 patients with COPD,there were 47 cases confirmed with active pulmonary tuberculosis.CT showed that incidence rates of emphysema,pneumothorax,intralesional calcification and bronchial opacity were 15.38%,18.46%,20.00%and 24.62%,higher than those of chest X-ray(4.62%,6.150%,7.69%,10.77%;P<0.05).CT and chest X-ray showed that there were 46 cases and 39 cases with COPD combined with active pulmonary tuberculosis,respectively.There was no significant difference in the diagnostic specificity,positive predictive value or negative predictive value between CT and chest X-ray(94.44%,97.83%,89.47%vs 94.44%,97.44%,65.38%;P>0.05).The sensitivity and accuracy of CT were higher than those of chest X-ray(95.74%,95.38%vs 80.85%,84.62%;χ^(2)=5.045,4.188,P=0.025,0.041).Kappa values of CT and chest X-ray were 0.887 and 0.662,respectively.Conclusion The diagnostic sensitivity and accuracy of CT are better than those of chest X-ray in COPD combined with active pulmonary tuberculosis,which has higher consistency with clinical diagnosis.

关 键 词：慢阻肺 活动性肺结核 胸部X线 CT 临床特征 诊断价值 

分 类 号：R445.3[医药卫生—影像医学与核医学] R521[医药卫生—诊断学]