新发、复发活动性肺结核及陈旧性肺结核影像学诊断的比较研究

    查期1，陈磊1，续晋铭2，方筠1，章琪1

　　1．上海国际旅行卫生保健中心，上海 200335；2．同济大学附属杨浦医院

　　摘要：目的  分析新发、复发活动性肺结核及陈旧性肺结核的影像学特征，探讨影像学诊断对结核活动性判断的临床应用价值。方法 收集活动性肺结核55例，其中新发34例，复发肺结核21例和陈旧性肺结核50例，对比分析3组肺结核的影像资料。结果 活动性影像学征象：小叶中心结节影、树芽征、小叶样实变、亚段以上实变、磨玻璃影、空洞征在新发肺结核中检出率依次为：79.4％、61.8％、67.6％、35.3％、73.5％、41.2％；复发组为71.4％、57.4％、57.1％、33.3％、66.7％、38.1％；陈旧性肺结核分别为20.0％、16.0％、18.0％、2.0％、32.0％、4.0％。新发和复发活动性肺结核在活动性影像征象检出率方面比较差异无统计学意义（P> 0.05），但与陈旧性肺结核比较差异有统计学意义（P <0.05）。非活动性影像学征象：纤维条索影、钙化、支气管扩张、肺气肿在新发肺结核中检出率依次为：8.8％、11.8％、8.8％、5.8％；复发组为52.4％、71.4％、38.1％、38.1％；陈旧性肺结核分别为84.0％、78.0％、44.0％、80.0％。纤维条索影、肺气肿检出率在3组间比较，差异有统计学意义（P< 0.05）。钙化和支气管扩张在复发与陈旧性肺结核中的检出率比较，差异无统计学意义（P >0.05），但与新发肺结核比较，差异有统计学意义（P < 0.05）。结论 活动性影像学征象有助于活动性肺结核的诊断，但尚需密切结合临床和痰检检查。

　　关键词：肺结核；活动性；复发；影像诊断

　　中图分类号：R521.1  文献标识码：B

　　Comparative study of imaging diagnosis in newly, relapsedactive

　　and inactive pulmonary tuberculosis

　　ZHA Qi*， CHEN Lei， XU Jin-ming， FANG Yun， ZHANG Qi

　　*Shanghai International Travel Healthcare Center， Shanghai200335， China

　　Abstract： Objective  To explore imaging characteristics innewly， relapsed active and inactive pulmonary tuberculosis， and toinvestigate the clinical value of the radiological diagnosis inactive tuberculosis. Methods  Comparison research was adoptedin 55 active PTB cases， including 34 newly and 21 relapsed PTBcases and 50 inactive PTB cases. The difference of the imagingmanifestations among the three kinds of PTB cases were observed.Results  Active imaging symptoms: the check-out rates ofcentrilobular nodules， tree-in-bud sign， lobular consolidation,segmental and subsegmental consolidation, ground-glass opacity andcavity were 79.4％、 61.8％、 67.6％、 35.3％、 73.5％、 41.2％ in newlydiagnosed cases； 71.4％、 57.4％、 57.1％、 33.3％、 66.7％、 38.1％ inrelapsed cases and 20％、 16％、 18％、 2％、 32％、 4％ in inactive cases.There was not significant difference of the above check-out ratesbetween newly and relapsed cases， while there was significantdifference compared with the inactive cases. Inactive imagingsymptoms: the check-out rates of the fiber rope band， calcify，bronchiectasis and emphysema were 8.8％、 11.8％、 8.8％、 5.8％ in newlydiagnosed cases； 52.4％、 71.4％、 38.1％、 38.1％ in relapsed cases and84％、 78％、 44％、 80％ in inactive cases. The difference of the ratesof the fiber rope band and emphysema was significant among threekinds of PTB cases. There was not significant difference of therates of calcify and bronchiectasis between relapsed and theinactive cases， while there was significant difference comparedwith the newly cases. Conclusion  Active imagingmanifestations is helpful to the diagnosis of the active PTB， whilecarefully considering the clinical symptoms and sputum examinationsare necessary at the same time.

　　Key words： Pulmonary tuberculosis； Activity； Relapsed； Imagingdiagnosis

　　《中国国境卫生检疫杂志》2014年4期