非结核分枝杆菌肺病的不同菌种CT特征及预后分析  

CT characteristics and prognostic analysis of different strains in non-tuberculosis mycobacterial pulmonary disease

作　　者：文小检 陈文琼 凌杰 文素利 WEN Xiao-jian;CHEN Wen-qiong;LING Jie(Department of Radiology,Hunan Chest Hospital,Changsha 410205,China)

机构地区：[1]湖南省胸科医院放射科,长沙410205 [2]上海市浦东新区大团社区卫生服务中心,上海201311

出　　处：《放射学实践》2025年第3期313-318,共6页Radiologic Practice

摘　　要：目的:探讨不同菌种非结核分枝杆菌(NTM)肺病的影像学特征,分析其预后情况,为NTM肺病的早期诊断及合理防治提供依据。方法:回顾性分析2021年1月-2024年1月在湖南省胸科医院住院治疗的NTM肺病患者458例,收集患者的年龄、性别、基础疾病、菌种信息、治疗方案及CT资料。比较不同菌种组一般资料及CT表现的差异,并分析不同预后患者的基线影像学表现资料的差异。结果:458例NTM患者中,脓肿分枝杆菌163例(35.56%)、胞内分枝杆菌153例(33.34%)、鸟分枝杆菌67例(14.63%)、鸟-胞内复合分枝杆菌5例(1.09%)、戈登分枝杆菌34例(7.42%)、其他分枝杆菌36例(7.86%)。NTM肺病患者中有448例(97.81%)出现不同程度支气管扩张,右中叶(379例,84.60%)及左肺上叶舌段(367例,81.92%)受累最常见。不同菌种组患者支气管管壁增厚伴周围炎、远段支气管局部扩张、纤维空洞、纤维化等影像学表现差异有统计学意义。脓肿分枝杆菌组患者的支气管管壁增厚伴周围炎发生率高,高达71.17%,胞内分枝杆菌、鸟分枝杆菌组的远段支气管局部扩张及纤维空洞发生率较高,胞内分枝杆菌组患者更容易合并纤维化。不同菌种NTM的预后情况比较差异有统计学意义(P<0.05)。CT复查显示NTM肺病患者预后良好108例和预后不良350例,两组患者之间支气管管壁增厚伴周围炎、树芽征、纤维空洞、纤维化比较差异有统计学意义。结论:CT可为NTM肺病的诊断及菌种鉴别有一定的提示作用,及时诊断可提高患者预后,有利于该类疾病的及时防治。Objective:To explore the imaging characteristics of pulmonary diseases caused by different strains of non-tuberculosis mycobacteria(NTM)and analyze their prognosis,thereby providing a basis for the early diagnosis and rational prevention and treatment of NTM pulmonary diseases.Methods:A retrospective analysis was conducted on 458 patients with NTM pulmonary disease who were hospitalized in Hunan Provincial Chest Hospital from January 2021 to January 2024.The age,gender,underlying disease,bacterial strain information,treatment regimens,and CT data of the patients were collected.The differences in general information and CT findings among different bacterial groups were compared,and the differences in baseline imaging manifestations between patients with different prognoses were analyzed.Results:Among the 458 NTM patients,163 cases(35.56%)were Mycobacterium abscessus,153 cases(33.34%)were Mycobacterium intracellulare,67 cases(14.63%)were Mycobacterium avium,5 cases(1.09%)were Mycobacterium avium-intracellulare complex,34 cases(7.42%)were Mycobacterium Gordonae,and 36 cases(7.86%)were other mycobacteria.Among NTM pulmonary disease patients,448 cases(97.81%)presented with varying degrees of bronchiectasis,with the right middle lobe(379 cases,84.60%)and lingular segment of the left upper lobe(367 cases,81.92%)being the most commonly affected.There were statistically significant differences in imaging manifestations,such as bronchial wall thickening with peribronchitis,local dilation of distal bronchi,fibrotic cavities,and fibrosis among patients with different bacterial strains.The incidence of bronchial wall thickening with peribronchitis was high in patients with Mycobacterium abscessus,reaching up to 71.17%.The incidences of local dilation of distal bronchi and fibrotic cavities were higher in the Mycobacterium intracellulare and Mycobacterium avium groups,and patients with Mycobacterium intracellulare were more likely to develop fibrosis.There were statistically significant differences in the prognosis of differen

关 键 词：分枝杆菌 非结核分枝杆菌肺病 体层摄影术 X线计算机 预后 防治 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.1[医药卫生—放射医学]