MSCT在非结核分枝杆菌肺病中的诊断价值及误漏诊影响因素分析  

Diagnostic Value of MSCT in Non-tuberculous Mycobacterial Lung Disease and Influencing Factors of Misdiagnosis and Missed Diagnosis

作　　者：官权 任会丽[1] 邬丽娟[2] GUAN Quan;REN Huili;WU Lijuan(Department of Radiology,Guangzhou Chest Hospital,Guangzhou 510000,China;Department of Tuberculosis,Guangzhou Chest Hospital,Guangzhou 510000,China)

机构地区：[1]广州市胸科医院放射科,广州510000 [2]广州市胸科医院结核内科,广州510000

出　　处：《临床误诊误治》2025年第6期22-27,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析非结核分枝杆菌(NTM)肺病患者多层螺旋电子计算机断层扫描(MSCT)影像学特征、诊断价值及误漏诊影响因素。方法选择2022年1月至2024年1月检查的128例疑似NTM肺病患者,行MSCT和病理学检查。根据结果分为误漏诊组和诊断正确组,分析2组MSCT影像学和误诊病例特征。分析影响NTM误漏诊的因素。潜在类别分析(LCA)比较因素分布特征差异。结果128例疑似患者中,经病理确诊94例,MSCT检出NTM肺病患者89例。以病理结果为金标准,MSCT确诊率为86.17%(81/94),漏诊率为13.83%(13/94),误诊率为8.51%(8/94)。误漏诊组胸膜增厚、肺气肿、毁损肺、淋巴结增大和胸腔积液患者比例高于诊断正确组,气胸患者比例低于诊断正确组(P<0.05,P<0.01)。多因素logistic回归分析结果显示,胸膜增厚、肺气肿、毁损肺、淋巴结增大、胸腔积液和气胸是影响NTM肺病诊断的因素(P<0.05)。LCA表明上述因素对NTM肺病误漏诊的影响具有异质性。结论NTM肺病和肺结核临床症状和CT影像相似,易误诊。MSCT在NTM诊断中具有良好的价值。胸膜增厚、肺气肿、毁损肺、淋巴结增大、胸腔积液和气胸是影响NTM肺病误漏诊的重要因素。Objective To analyze the imaging features,diagnostic value and influencing factors of misdiagnosis and missed diagnosis of multi-slice spiral computed tomography(MSCT)in patients with non-tuberculous mycobacterial(NTM)lung disease(NTM-LD).Methods From January 2022 to January 2024,128 patients with suspected NTM-LD were selected and underwent MSCT and pathological examination.According to the results,the patients were divided into misdiagnosis and missed diagnosis group and correct diagnosis group,and MSCT imaging and characteristics of misdiagnosed cases in the two groups were analyzed.Multivariate logistic regression analysis of the factors affecting the misdiagnosis and missed diagnosis of NTM-LD was performed,and latent class analysis(LCA)was used to compare the differences in the distribution characteristics of factors.Results Among the 128 suspected patients,94 patients were pathologically confirmed,and MSCT detected 89 NTM-LD patients.Using the pathological result as the standard,the detection rate of MSCT was 86.17%(81/94),the missed diagnosis rate was 13.83%(13/94),and the misdiagnosis rate was 8.51%(8/94).The proportion of pleural thickening,emphysema,lung destruction,enlarged lymph node and pleural effusion in misdiagnosis and missed diagnosis group was significantly higher than that in correct diagnosis group,and the proportion of pneumothorax in misdiagnosis and missed diagnosis group was significantly lower than that in correct diagnosis group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that pleural thickening,emphysema,lung destruction,lymph node enlargement,pleural effusion and pneumothorax were influencing factors of the diagnosis of NTM-LD(P<0.05).LCA showed that the influence of the above factors on the misdiagnosis and missed diagnosis of NTM-LD was heterogeneous.Conclusion The clinical symptoms of NTM-LD patients and pulmonary tuberculosis are similar to CT images,which is prone to misdiagnosis.MSCT has good diagnostic value in the diagnosis of NTM-LD.Pleural thickening,emp

关 键 词：非结核分枝杆菌 体层摄影术 螺旋计算机 病理 误漏诊 结核 肺 肺气肿 胸腔积液 气胸 

分 类 号：R517.9[医药卫生—内科学]