曹文斌 高特 叶春绿

摘要：目的：探析在肺结核治疗后复查病例诊断中进行低剂量螺旋CT检查与X线胸片技术检查的准确性。方法：选取2017年5月-2020年6月我院收治的60例肺结核患者作为观察对象，根据不同的检查方法分为CT组和X线组，CT组30例患者均采用低剂量螺旋CT进行检查，X线组30例患者均采用X线胸片技术检查。分析两种方法的诊断结果。结果：CT组诊断准确率93.33%明显高于X线组70.00%;CT组和X线组支气管播散灶检出率分别为63.33%、46.67%，卫星灶检出率分别为56.67%、40.00%，空洞检出率分别为86.67%、60.00%，淋巴结肿大检出率分别为13.33%、3.33%，胸膜增厚检出率分别为20.00%、46.67%，胸水检出率分别为13.33%、3.33%，兩组对比差异较大（P<0.05）;同时，CT组和X线组对肺结核诊断的敏感度分别为83.59%、71.52%，特异度分别为86.49%、74.92%，阳性预测值分别为86.29%、70.42%，阴性预测值分别为83.92%、70.42%，两组对比差异较大（P<0.05）;与X线组的检查满意度（86.67）相比，CT组腹检查的满意率（96.67）更高，两组对比差异较大（P<0.05）。结论：在肺结核治疗后复查病例中采用低剂量螺旋CT的诊断准确率明显高于X线胸片，且CT的肺结核病理特征检出率较高，有助于减少误诊，改善医患关系，可在临床上进一步推广。

关键词：肺结核;低剂量螺旋CT;X线胸片;诊断准确性

中图分类号：R445.4文献标识码：BDOI：10？郾3969/j.issn.1001-0270.2021.03.08

Abstract： Objective： To explore the accuracy of low-dose spiral CT and X-ray in the diagnosis of pulmonary tuberculosis after treatment. Methods： A total of 60 patients with pulmonary tuberculosis were selected as the observation objects， all from May 2017 to June 2020， and they were divided into CT group and X-ray group according to different examination methods. 30 patients in CT group were examined by low-dose spiral CT， and 30 patients in X-ray group were examined by X-ray chest film technology. The diagnosis results of the two methods were analyzed. Results： The diagnostic accuracy of CT group was 93.33%， which was significantly higher than that of X-ray group （70.00%）. The detection rates of bronchial dissemination， satellite focus， cavity， lymphadenopathy， pleural thickening and pleural effusion were 63.33% and 46.67%， 56.67% and 40.00%， 86.67% and 60.00%， 13.33% and 3.33% respectively There was significant difference between the two groups （P<0.05）.At the same time， the sensitivity， specificity， positive predictive value and negative predictive value of CT group and X-ray group were 83.59%， 71.52%， 86.49%， 74.92%， 86.29%， 70.42%， respectively. There was a big difference between the two groups （P<0.01） Compared with X-ray group （86.67）， the satisfaction rate of abdominal examination in CT group （96.67） is higher， and there is a big difference between the two groups （P<0.05）. Conclusion： The diagnostic accuracy of low-dose spiral CT is significantly higher than that of X-ray chest film， and the detection rate of pathological features of pulmonary tuberculosis by CT is higher， which helps to reduce misdiagnosis andimprove the doctor-patient relationship，can be further promoted in clinic.

Key Words： Pulmonary tuberculosis; Low dose spiral CT; Chest X-ray; Diagnostic accuracy

肺结核是常见的慢性呼吸系统疾病，由结核杆菌感染导致，具有较高的传染性、发病率、死亡率，主要发生在中老年人群中，对人们健康生活和生命安全造成严重威胁。随着老龄化不断加剧，该疾病发病率也越来越高[1]。据相关统计，每年全世界肺结核发病人数为800-1000万人。针对肺结核病患临床建议早诊断、早治疗[2]。影像学技术不断发展，其在肺部疾病诊断中也具有显著作用。现阶段临床上主要采用螺旋CT和X线胸片对肺结核病患进行治疗后复查，但是后者辐射较大，对患者的身体伤害也较大，X线胸片可以发现部分病变，但对直径1cm以下的早期诊断肺结核病灶存在检查局限性。临床上更多使用螺旋CT进行检查，其数据采集高速且连续，通过横截面断层成像，有利于提高早期临床对肺结核病变的检出能力[3]。……