杨振

摘 要：分析探讨中青年不同病理基础为主的肺结核的CT表现特点及其抗结核治疗后疗效评价价值。回顾分析临床治疗观察或病理证实的肺结核90例患者抗结核治疗后3个月、9个月及12个月的CT特征和最后诊断。结果本组90例中青年结核患者中，肺实质出现的病变、CT征象以增殖结节灶最多，检出率100%，其次是实变及磨玻璃样征象；以间质为主的征象中，小叶间隔增厚征象检出率最高51.1%，其次是细支气管壁增厚及树芽征象。肺结核病理进展与转归是肺结核影像诊断的基础，肺结核是一种特异性炎症，渗出、增殖和变质三种炎症病理改变同时存在，而以某一种改变为主。从病理角度出发结合CT征象综合分析，对于肺结核的诊断及疗效观察具有重要的参考价值。

关键词：肺结核；计算机断层扫描，病理分析；治疗

中图分类号： R521 文献标志码：A [WT]文章编号：1672-1098（2017）03-0079-05

Abstract：Analysis is made in this paper of the CT manifestation characteristics and its anti-tb treatment curative effect assessment value in young and middle-aged tuberculosis patients with different pathological basis 90 tuberculosis patients confirmed byclinical observation or pathology were undergone by anti-tuberculosis treatment for 3 months， 9 months， 12 months， and their CT features and the final diagnosis were carefully reviewed. Results of 90 cases of young and middle-aged patients with tuberculosis show that lung parenchyma lesions， CT signs with proliferation focal nodules ranked the most， with the detection rate 100%， followed by consolidation and ground-glass opacity signs； and that among the interstitial signs， interlobular septal thickening signs detection rate was up to 51.1%， followed by thin bronchial wall thickening and sprouts signs. Tuberculosis pathologic progress and reclassification is the basis of the diagnosis of tuberculosis， tuberculosis is a specific inflammation， with hree inflammatory pathological changes of seepage， proliferation and metamorphic existing at the same time， while one certain change as the dominant. Comprehensive analysis from the perspective of the pathological combining CT signs would have the important reference value for the diagnosis of tuberculosis and clinical observation.

Key words：Tuberculosis； Computed tomography； Pathological analysis； Treatment 肺結核是一种慢性传染性疾病。结核菌进入人体后不一定发病，仅于抵抗力低落时方始发病[1]。本病的病理特点是渗出、增殖及变质，并可形成结节、干酪坏死及空洞[2]。渗出性为主的病灶，浆液纤维素炎为特征。增殖灶为主的病灶，结核性肉芽肿为特征。变质性为主的病灶，干酪性坏死为特征。渗出性病灶经过治疗，免疫力上升可以转化为增殖病灶；相反当机体免疫力下降，变态反应增高，增殖性病灶可以转化为渗出性病灶。当机体免疫力下降，变态反应增强，渗出及增殖性病变也可以转化为变质病变，即干酪样坏死灶。……