杨登法　　杨铁军　　叶啸　　华浅近　　丁力　　王林友　　杨亦德

[關键词] 肺结核;菌阴;体层摄影术;X线计算机

[中图分类号] R445.3          [文献标识码] B          [文章编号] 1673-9701（2021）14-0123-04

Analysis of the MSCT manifestations of 59 cases of initially treated active pulmonary tuberculosis with bacteria-negative

YANG Dengfa1   YANG Tiejun1   YE Xiao1   HUA Qianjin1   DING Li1   WANG Linyou1   YANG Yide2

1.Department of Radiology， Taizhou Municipal Hospital， Taizhou   318000， China; 2.Department of Infectious Diseases， Taizhou Municipal Hospital， Taizhou   318000， China

[Abstract] Objective To investigate the MSCT manifestations of initially treated active pulmonary tuberculosis with bacteria-negative and improve the disease's understanding. Methods A total of 59 cases of initially treated active pulmonary tuberculosis with bacteria-negative who had complete data in our hospital from January 2016 to October 2019 were collected. Two chest imaging experts read the pictures， analyzed and recorded the chest MSCT features of the disease. Results Fifty-nine cases of active pulmonary tuberculosis with bacteria-negative were absorbed better after six months of regular drug treatment. Among them， 40 were males， and 19 were females， aged 16-68 years， with an average age of 33.2 years. Lung lesions mainly affected the upper lobes of the two lungs， of which 15 cases of upper lobes of both lungs were simultaneously affected， only the left upper lobe was affected in 16 cases， and only the right upper lobe was affected in 11 cases. There were 8 cases of affected lower lobes of both lungs， 6 cases of affected upper and lower lobes of both lungs， and 3 cases of diffuse involvement of both lungs. Among the MSCT signs of initially treated active pulmonary tuberculosis with negative bacteria， there were 55 cases of central lobular nodules， 50 cases of acinar nodules， 47 cases of tree bud sign， 28 cases of lobular consolidation， 26 cases of ground glass shadow， and 18 cases of consolidation with fuzzy edges， 15 cases of bronchial wall thickening， 9 cases of thick-walled cavities， and 3 cases of multiple small cavities within nodules. The detection rates of the above signs were 93.2%， 84.7%， 79.7%， 47.5%， 44.1%， 30.5%， 25.4. %， 15.3%， and 5.08%. Among the MSCT signs of inactive pulmonary tuberculosis， 16 cases were plaques， 15 cases were high-density nodules with clear edges， 14 cases were streak shadow， 14 cases were calcification， 3 cases were bronchiectasis， and 2 cases were distorted and deformed lung structure. The detection rates of the above signs were 27.1%， 25.4%， 23.7%， 23.7%， 5.09%， and 3.39% respectively. Conclusion Central lobular nodules， acinar nodules， and tree bud signs are the most common signs of MSCT in newly treated active pulmonary tuberculosis with bacteria-negative， representing the characteristics of easy bronchial spread of Mycobacterium tuberculosis. Combining the lesion's location and shape can improve the accuracy of the diagnosis of active pulmonary tuberculosis with bacteria-negative.

[Key words] Tuberculosis; Bacteria-negative; Tomography， X-ray computer

结核病是严重危害人类健康的公共传染病，也是全球性的社会问题和公共卫生问题。WHO估算我国2018年有86.6万新发结核病例，次于印度，成为位居全球第2位[1]。菌阴肺结核即三次痰菌涂片、一次痰培养均呈阴性的肺结核[2-3]，大约占全部肺结核的40%～60%[4]。近年来，国内外研究显示：菌阴肺结核具有传染性，与其接触者被感染的几率在7.3%～21.0%，如未及时治疗可导致病灶传播和恶化[3]，因此，菌阴肺结核患者是结核病控制工作中不可忽视的群体。众所周知，初治菌阴肺结核缺少临床特点，痰菌和痰培养多为阴性，仅影像上表现为肺部不同形态病变，成为临床诊断和鉴别的难点[5-6]。影像学诊断在菌阴肺结核的诊断中发挥重要作用，若对该病缺乏认识，可能很难及时准确地作出诊断，耽误病情。因此，笔者收集分析59例初治菌阴活動性肺结核的MSCT表现，以资对该病有更深的认识，提高该病诊断准确性。

1 资料与方法

1.1 一般资料

搜集2016年1月至2019年10月在我院登记的初治菌阴肺结核患者197例，其中初治在我院检查、资料完整、抗结核治疗有效的菌阴肺结核患者59例。男40例，女19例，年龄16～68岁，平均年龄33.2岁。32例有不同程度临床症状，包括咳嗽咳痰13例，咯血5例，发热5例，消瘦3例，夜间盗汗2例，胸闷2例，胸背部疼痛2例，27例患者在体检时发现。入选病例均在我院行CT检查，治疗前、治疗2个月、6个月后分别复查CT。……