不典型活动性肺结核的多层螺旋CT表现及临床特征分析

doi:10.19871/j.cnki.xfcrbzz.2025.04.004

摘要/Abstract

摘要： 目的分析不典型活动性肺结核的多层螺旋CT（multi-slice spiral computed tomography,MSCT）表现及临床特征,提高对不典型活动性肺结核的认识,为临床处理提供影像依据。方法收集2018年1月至2024年6月广州市胸科医院影像表现不典型活动性肺结核患者138例、典型继发性肺结核病例（典型继发组）150例及典型血行播散性肺结核病例（典型血播组）41例,将不同类型不典型肺结核与对应的典型组的CT影像特征及相关临床特征进行对比分析。结果 138例不典型肺结核病例根据CT表现分为间质型48例、肿块型24例、多发结节型46例、多发囊样变型11例、实变型9例。间质型MSCT主要表现为“烟花征”,临床症状轻,菌阴率高于典型继发性肺结核（P<0.05）。肿块型患者的肺内多发肿块占比高于单发肿块,两上肺病灶占比低于典型继发组,病灶内钙化及预后延迟占比、发病年龄明显高于典型组（P<0.05）。多发囊样变型表现为多发肺气囊沿支气管束分布,64%（7/11）病例合并磨玻璃影,该组预后延迟与预后不佳占比明显高于典型继发组（P<0.05）。多发结节型表现为两肺随机分布结节,结节大于粟粒结节,合并其他系统结核占比高于典型组（P<0.05）。实变型表现为多发叶、段实变影及斑片影,右肺中叶病变占比高于典型继发组,33%（3/9）病例合并磨玻璃影,该组预后延迟及预后不佳占比高于典型组,组间对比有统计学差异（P< 0.05）。除间质型肺结核,其他各组不典型肺结核的合并基础疾病的占比高于对应典型组（P<0.05）。结论多数不典型肺结核的MSCT影像表现及分布有较强的特异性,合并基础疾病、预后延迟占比高。

关键词: 不典型肺结核, 计算机断层扫描, 烟花征, 肿块, 多发囊样变, 多发结节, 肺实变

Abstract: Objective To analyze MSCT features and clinical characteristics of atypical active pulmonary tuberculosis,to improve the understanding of atypical active pulmonary tuberculosis and to provide an imaging basis for clinical treatment. Method A total of 138 patients with atypical active pulmonary tuberculosis, 150 cases with typical secondary pulmonary tuberculosis (typical secondary group) and 41 cases with typical hematogenous disseminated pulmonary tuberculosis (typical hematogenous group) from January 2018 to June 2024 were collected at Guangzhou Chest Hospital. The CT image features and clinical features of different types of atypical pulmonary tuberculosis were compared and analyzed with the corresponding typical groups, and the imaging and clinical features of each type of atypical pulmonary tuberculosis were summarized. Result According to CT findings, 138 cases of atypical pulmonary tuberculosis were divided into interstitial type (48 cases), mass type (24 cases), multiple nodule type (46 cases), multiple cystic type (11 cases) and consolidation type (9 cases). "Fireworks sign" was showed in interstitial type, the clinical symptoms were mild, and the bacterial negative rate was higher in interstitial type than that of typical secondary group (P<0.05). In the patients with mass type, the rate of multiple pulmonary masses was higher than that of single mass, the rate of lesions in both upper lobes was lower than that in the typical secondary group, and the rate of calcification, delayed prognosis and age of onset was significantly higher than that of typical group (P<0.05). Type of multiple cystic variants was characterized by multiple pulmonary air sacs distributed along the bronchial tract, 64% (7/11) of which were complicated by ground-glass-opacity, and the ratio of delayed prognosis and poor prognosis in this group was significantly higher than that in typical secondary group (P<0.05). Random distribution of nodules in both lungs were showed in type of multiple nodules, which were larger than miliary nodules, and the rate of cases combined with other systemic tuberculosis was higher than that in Typical hematogenous group (P<0.05). The results showed that the incidence of lesions in the right middle lung in consolidation type was higher than that of typical secondary group, 33% (3/9) of which were combined with ground-glass-opacity, and the rate of delayed prognosis and poor prognosis in consolidation type was significally higher than that in the typical secondary group (P<0.05). Except for the interstitial type, the rate of combined underlying diseases in other types of atypical pulmonary tuberculosis was higher than that in the corresponding typical group (P<0.05). Conclusion The CT manifestations and distribution of most atypical pulmonary tuberculosis are highly specific, with high rates of underlying diseases and delayed prognosis.

Key words: Atypical pulmonary tuberculosis, Computed tomography, Fireworks sign, Mass, Multiple cystic lesions, Multiple nodules, Lung consolidation

中图分类号:

R814.42

宋敏, 方伟军, 韩远远, 梁瑞云. 不典型活动性肺结核的多层螺旋CT表现及临床特征分析[J]. 新发传染病电子杂志, 2025, 10(4): 19-26.

Song Min, Fang Weijun, Han Yuanyuan, Liang Ruiyun. Analysis of MSCT manifestation and clinical features of atypical active pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 19-26.

参考文献

[1] WORLD HEALTH ORGANIZATION.Global tubcrculosis report2024[EB/OL].Genceva:World Health Organization,2024.www.who.int/teams/global-tuberculosis-programme.
[2] 王前, 李涛, 杜昕, 等. 2015—2019年全国肺结核报告发病情况分析[J]. 中国防痨杂志, 2021, 43(2): 107-112.
[3] ZENG Y, ZHAI XL, WANG YXJ, et al.llustration of anumber of atypical computed tomography manifestations of active pulmonary tuberculosis[J]. Quant Imaging Med Surg, 2021, 11(4):1651-1667.
[4] 方瑞, 吴重重, 吴坚, 等. 活动性肺结核的烟花征CT表现[J].中华放射学杂志, 2019, 53(3):196-199.
[5] 宋敏, 刘文, 方伟军, 等. 肺结核患者的不典型CT表现[J].中国防痨杂志, 2013, 35(3):168-172.
[6] 黎惠如, 方伟军, 刘曾维, 等. CT在单发结节或肿块型肺结核和肺癌鉴别中的作用研究[J/CD].新发传染病电子杂志, 2021, 6(4):323-326.
[7] HONG JH, YOON SH, GOO JM, et al.Clustered micronodules as predominant manifestation on CT: A sign of active but indolently evolving pulmonary tuberculosis[J]. PLoS ONE, 2020, 15(4):e0231537.
[8] 中华医学会放射分会传染病放射学专业委员会. 肺结核分级诊断影像学诊断专家共识[J/CD]. 新发传染病电子杂志, 2018, 3(2):118-127.
[9] ZHAN X, WANG Z, ZHANG L, et al.Clinical and pathological features of adult pulmonary tuberculosis with reversed halo sign[J]. Int J Tuberc Lung Dis, 2013, 17(12):1621-1625.
[10] 强军, 王兆宇, 姜春雷, 等. 肺结核反晕征的CT演变特征[J].中华放射学杂志, 2022, 56(4):372-376.
[11] 田扬, 赵卫, 罗罡, 等. 结节或肿块型不典型肺结核25例CT征象分析[J].昆明医科大学学报, 2014, 35(6):71-75.
[12] 张贺秋,赵雁林.现代结核病诊断技术[M].北京:人民卫生出版社,2013:105-106.
[13] 曾谊,侯代伦,张侠.老年肺结核的影像学表现[J].中国防痨杂志, 2018, 40(7):772-775.
[14] KO KS, LEE KS, KIM Y, et al.Reversible cystic disease associated with pulmonary tuberculosis: radiologic findings[J]. Radiology, 1997, 204(1):165-169.
[15] SINGH HK, MITAL OP.The radiological appearance of isoniazid cysts[J]. Indian J Chest Dis Allied Sci, 1968, 10(4):208-210.
[16] FERNANDEZ A, SHAH MD, BUHANIWALLA RJ.Multiple isoniazid cysts in a child with chronic pulmonary tuberculosis[J]. Indian Pediatr, 1972, 9(1):49-50.
[17] HOU S, SHEN J, TAN J.Case report: multiple systemic disseminated tuberculosis mimicking lymphoma on 18F-FDG PET/CT[J]. Medicine, 2017,96(29):e7248.
[18] YU WY, LU PX, ASSADI M, et al.Updates on 18F-FDG-PET/CT as a clinical tool for tuberculosis evaluation and therapeutic monitoring[J]. Quant Imaging Med Surg, 2019, 9(6):1132-1146.
[19] 舒伟强, 李春华, 王惠秋, 等.2型糖尿病并发肺结核患者血糖水平与CT特征的相关性分析[J].中国防痨杂志, 2017, 39(6):565-569.
[20] NAKAO A, ISHII H, IGATA F, et al.Disseminated tuberculosis with acute respiratory distress syndrome lacking granuloma formation in the lung[J]. J Infect Chemother, 2016, 22(9):638-641.
[21] LEE J, LIM JK, SEO H, et al.Clinical relevance of groundglass opacity in 105 patients with miliary tuberculosis[J]. Respir Med, 2014, 108:924-930.