涂阳活动性肺结核患者HRCT评分与细菌学及免疫学相关性分析

目的探讨HRCT评分标准在诊断活动性肺结核中的应用价值。方法对42例痰涂阳性肺结核患者，进行HRCT检查和评分，每侧肺组织划分为为三个区域，分别对各类型CT征象所累及范围进行评分；分析评分结果与痰细菌学检查结果和外周血结核菌特异性IFN—y水平之间的相关性。结果根据结核菌涂片结果分为4组，其中，AFB（＋）12例、AFB（＋＋）11例、AFB（＋＋＋）10例、AFB（＋＋＋＋）9例，相关性分析显示（1）HRCT总评分与痰阳性分级有正相关性（r=0．9661 P〈0．0001）：（2）HRCT总评分与结核菌抗原ESAT6、P4-6、P8．10特异性IFN—y释放水平均呈正相关（r=0．4805，P=0．0017，r=0．4451，P=0．0083，r=0．4211，P=0．0131）。结论以活动性肺结核患者复杂的CT征象的范围为基础的HRCT评分标准与细菌学及免疫学均呈正相关，表明该HRCT评分标准对临床诊断治疗和疗效判定具有一定指导意义。

Correlations between scores of high-resolution CT findings of patients with mycobacterium positive pulmonary tuberculosis and bacteriology and immunology of pulmonary tuberculosis

Objective To investigate the role of HRCT scanning scores in diagnosis of active pulmonary tuberculosis（PTB） patients. Methods 42 PTB patients that sputum smear were mycobacterium positivity were included into the study. Every lung field was divided into 3 zones. Extent to disease in each zone abnormalities was evaluated and summed to a HRCT score. The correlation between HRCT scores and release levels of specific IFN-y in peripheral blood Bacillus tuberculosis as well as sputum bacteriology result. Results Smear mycobacterium positive patients with PTB were divided into 4 groups according to grades of sputum acid-fast bacillus （AFB） smear： group Ⅰ （sputum 1＋, n=12）, group Ⅱ （sputum 2＋, n=11）, group Ⅲ （sputum 3＋, n=10）, and group Ⅳ （sputum 4＋, n=9）.The correlation analysis demonstrated： （1） A positive correlation between total scores based on HRCT and the degree of smear positivity was found （ r =0.9661 P〈0.0001 ）. （ 2 ） There are positive correlations between total scores of HRCT findings and release levels of ESAT6, P4-6, P8.10 specific IFN- y （r =0.4805 P=0.0017; r =0.4451, P=0.0083; r =0.4211, P=0.0131）. Conclusion The score standards of HRCT based on multiplex CT signs in patients with PTB correlated positively with bacteriology and immunology. HRCT scores can be used to evaluate degrees of lung injury and have a critical role in guiding clinical diagnosis and therapeutic effect assessment of active PTB patients.