高分辨率CT在非结核分枝杆菌肺病诊治中的价值

搜集广州市胸科医院2015年3月至2017年9月经菌种鉴定为非结核分枝杆菌(NTM)肺病、并行胸部高分辨率CT(HRCT)检查的99例患者,回顾性分析肺内病灶部位、数量、形态、大小、密度、边界、分布及淋巴结的CT征象;评估99例NTM肺病患者治疗前后HRCT的表现。HRCT检查表现为斑点片状渗出、实变93例,支气管扩张78例,空洞60例,纤维条索状影59例,结节状影58例,树芽征55例,磨玻璃样影46例,淋巴结肿大45例,胸膜增厚18例,胸腔积液9例,病变通常以多种形态混杂存在。91例NTM肺病患者经克拉霉素、利福平、乙胺丁醇及阿米卡星治疗6~18个月后CT复查,显示病灶均减少;8例患者经HRCT精准定位后行患侧肺叶切除术,术后肺部病灶明显减少,但均出现术侧胸膜肥厚粘连。胸部HRCT对NTM肺病的诊断及治疗具有重要的应用价值。

The value of high resolution CT in the diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases

Retrospective analysis high resolution computed tomography (HRCT)of 99 cases of patients with non-tuberculous mycobacteria (NTM) lung disease in Guangzhou Chest Hospital from March 2015 to September 2017. The location, number, shape, size,density, border and distribution of lung lesions and lymph nodes were analysed and HRCT findings before and after treatment was evaluated.The common signs of HRCT in NTM lung disease were spotty effusion and consolidation in 93 cases, bronchiectasis in 78 cases, cavitary in 60cases,59 cases of fiber shade,58 cases of nodules, tree-in-bud pattern in 55 cases,grinded glass shadow in 46 cases,45 cases of lymphadenopathy,pleural thickening in 18 cases,pleural effusion in 9 cases, multiple forms was usually observed in one patient’s HRCT. Ninety-one patients with NTM lung disease were treated with clarithromycin, rifampicin, ethambutol and amikacin for 6-18months;8 patients underwent lobectomy after precise localization by HRCT and the lesions were significantly reduced after operation but there were pleural thickening adhesions. Chest HRCT plays an important role in the diagnosis and treatment of NTM lung disease.