涂阴、涂阳活动性肺结核CT征象的对照研究

目的探讨CT征象在涂阴和涂阳活动性肺结核诊断中的价值。方法搜集2006年1至11月间登记治疗的新发涂阴肺结核92例,涂阳肺结核90例,分别进行CT和HRCT扫描,观察两组CT征象的表现以及检出率的差异,筛选有助于诊断涂阴与涂阳活动性肺结核的有价值CT征象。结果毛玻璃密度影、节段分布小叶中心结节影、小叶样实变、网状及细线影,在涂阴组检出率分别为85.9%、84.8%、69.6%、22.8%;涂阳组分别为92.2%、90.0%、77.8%、30.0%(P>0.05)。空洞征、树芽征、气道壁增厚、段及亚段肺实变征象,涂阴组分别为19.6%、46.7%、69.6%和13.0%;涂阳组为61.1%、63.3%、84.4%、35.6%(P<0.05)。涂阳组气道壁破坏的CT征象明显高于涂阴组(P<0.05)。涂阴肺结核病变以累及单肺叶为主;涂阳组以多叶受累为主(P<0.01)。涂阳组检出的活动性CT征象种类多于涂阴组。结论涂阴与涂阳活动性肺结核的部分CT征象检出率具统计学意义,有助于涂阴活动性肺结核的临床诊断。

Contrast research of CT manifestations in active pulmonary tuberculosis with positive and negative smear

Objective To evaluate the value of CT manifestations in diagnosis of active pul monary tuberculosis with posi-tive and negative smear .Methods Ninety-two patients with negative smear and ninety patients with positive smear under-went CTand HRCT examination. Differences of CT manifestation and its occurrence between two groups were observed .Some valuable signs were selected .Results In negative smear group ,occurrences of ground-glass opacity ,lobular nodules ,lobular consolidation,reticular and linear shadows were 85 .9 %,84 .8 %,69 .6 %,and 22 .8 %,respectively . While in posi-tive smear group , occurrences of the above signs were 92 .2 %, 90 .0 %, 77 .8 %, and 30 .0 %,respectively .In negativesmear group ,occurrences of cavity ,tree-in-bud sign,thickening of bronchial wall ,segmental and subsegmental consolida-tion were 19 .6 %,46 .7 %,69 .6 %,and 13 .0 %,respectively . Whereas ,in positive smear group ,occurrences of the abovesigns were 61 .1 %,63 .3 %,84 .4 %,and 35 .6 %,respectively . All the data above between two groups were significantlydifferent (P<0 .05) . Occurrence of obstruction of bronchial wall in positive group was obviously higher thanthat of negativesmear group .Single lobe was al ways involvedin the negative smear group , while multiple lobes were ofteninvolvedin posi-tive smear group .In positive smear group CT manifestations representative of activity were found much more than negativesmear group .Conclusion Occurrences of some CT signs had statistical significance between two groups , which is helpfulfor clinical diagnosis of active pul monary tuberculosis with negative smear .