肺间质改变为主的继发性肺结核的CT诊断价值与疗效评价

目的 探讨以肺间质改变为主的继发性肺结核的CT表现特点及其在抗结核治疗后疗效评价的价值。 方法 收集CT扫描图像上以肺间质改变为主，且经过临床或病理证实的继发性肺结核患者43例，男23例，女20例，年龄范围19~54岁［平均(29±11.4)岁］。痰Mtb涂片检查阳性者29例，余经痰Mtb培养阳性、支气管镜、穿刺活检或临床治疗随访证实。所有患者均在抗结核治疗前后行多次CT检查，双盲法动态观察CT表现特点及其征象转归。 结果 该类型的肺结核好发于两肺上野（30/43），多为节段性分布，呈小片状或大片融合状，多数肺间质病变与正常肺组织界限清楚。CT上肺间质改变主要表现为小叶内细网织线影、微结节、树芽征、磨玻璃样密度影、小叶间隔增厚和气道壁增厚等，检出率分别为100.0%（43/43）、100.0%（43/43）、76.7%（33/43）、62.8%（27/43）、53.5%（23/43）和55.8%（24/43）。经抗结核治疗后以上肺间质性改变均有不同程度吸收，在巩固期末（6个月）后4种征象吸收率均达93%以上。 结论 以间质改变为主的肺结核是一种特殊类型的继发性肺结核，CT检查能够清晰客观显示该类型肺结核间质改变的特点，有助于该病的提示性诊断并可以观察和评价治疗的预后。

The value of CT appearances of interstitial changes in secondary pulmonary tuberculosis

Objective To explore the CT characteristics of interstitial changes in patients with secondary pulmonary tuberculosis and analyze the value of CT manifestations to evaluate the effects of anti-tuberculosis therapy.Methods Forty-three patients who were diagnosed as tuberculosis by clinical or pathology were enrolled into our study(male: 23,female: 20;age: 19-54 years old,average age(29±11.4) years old).All the cases showed interstitial changes on CT imaging.Twenty-nine cases were testified by sputum smear,and the other cases were testified by sputum culture,bronchoscopy,biopsy or clinical follow-up.All the cases underwent CT scans before and after anti-tuberculosis therapy.Double-blind method was used to analyze the dynamic changes and outcomes of CT appearances.Results The most common location of this kind of tuberculosis was in the bilaterally upper pulmonary lobes(30/43),mostly distributed in segments,in the form of a small lesion or large fusion lesion.The CT appearances of interstitial changes were mainly intra-lobular reticular reticulation(43/43,100.0%),micro-no-dule(43/43,100.0%),tree-in-bud(33/43,76.7%),ground-glass opacity(27/43,62.8%),thickening of inter-lobular septa(23/43,53.5%) and thickening of the airway wall(24/43,55.8%).The most cases showed clear boundary between the interstitial lesion and the normal lung tissue.The interstitial appearances improved after the anti-tuberculosis treatment,and more than 93% of the later four signs disappeared after the consolidation phase therapy(6 months).Conclusion It was a special kind of secondary tuberculosis which mainly manifested interstitial changes.The CT image could show us clear characteristics,and was helpful in detecting tuberculosis in the early phase,and evaluating the outcomes after therapy.