摘要
目的探讨耐多药肺结核患者的CT表现及其与CD4细胞的关系，以提高对耐多药肺结核的认识。方法回顾性分析2015年1月至2016年11月重庆市公共卫生医疗救治中心诊治的137例耐多药肺结核患者（观察组），及对抗结核药物敏感的肺结核患者130例（对照组）。根据CD4细胞〈200个／μl、200～400个／μl、〉400个／μl将观察组和对照组分别分为A、B、C及AI、BI、CI各3个小组。两组患者均做胸部CT扫描及CD4细胞检测。对病变范围、形态、性质等CT表现及CD4细胞水平进行统计学分析，并分析观察组的影像表现与CD4细胞水平的关系。结果观察组和对照组病变累及3个肺叶以上的患者分别为118例（86．1％）、69例（53．1％），全肺受累分别为84例（61．3％）、26例（20．0％），差异均有统计学意义（X^2=34．73，47．00，P值均〈0．01）。在病变形态上观察组与对照组分别为：多发播散结节85例（62．0％）、39例（30．0％），纵隔淋巴结肿大101例（73．7％）、29例（22．3％），多发空洞96例（70．1％）、22例（16．9％），胸膜增厚86例（62．8％）、36例（27．7％），增殖90例（65．7％）、35例（26．9％），纤维灶75例（54．7％）、28例（21．5％），并发毁损33例（24．1％）、7例（5．4％），支气管扩张95例（69．3％）、22例（16．9％），差异均有统计学意义（X^2=27．54，62．85，76．40，33．08，40．27，31．04，18．32，74．46，P值均〈0．05）。观察组空洞平均内径（30．3±4．9）mm，大于对照组的（21．3±4．2）mm（t=10．19，P〈0．01）。其中观察组A、B、C小组空洞平均内径分别为（21．4±3．0）mm、（24．7±3．4）mm、（30．7±3．9）mm，差异有统计学意义（F=60．56，P〈0．01）。观察组CD4细胞平均（425．6±156．5）个／μl，低于对照组的（734．4±215．6）个／μl（t=-13．45，P〈0．01）。B小组平均（303．8±57．9）个／μl，B1小组平均（352．3±65．3）个/μl，两小组比较差异有统计学意义（F=3．53，P〈0．01）。C小组平均（603．8±188．3）个／μl，C1小组平均（852．5±231．4）个／μl，两小组比较差异有统计学意义（t=-7．18，P〈0．01）。结论观察组CD4细胞低于对照组患者，前者肺内病灶分布广泛，容易多叶段受累、多发播散，多发空洞、慢性病程及并发症表现较多，其CT表现与CD4细胞的高低有一定关系。
Objective To investigate CT manifestations of multi-drug-resistant tuberculosis and its relationship with CD4 cells, in order to raise awareness of multi-drug-resistant tuberculosis. Methods In the retrospective analysis, 137 patients with multi-drug-resistant pulmonary tuberculosis from Chongqing Public Health Center between January 9,015 and November 2016 were taken as the observation group, and 130 patients with tuberculosis sensitive to anti-tuberculosis drugs during the same period were selected as the control group. According to CD4 cells （〈200/μl, 200 - 400/μl, 〉400/μl）, the observation group and the control group were divided into three subgroups （A, B, C and A1, B1, C1）. Patients in both groups undertook chest CT scan and CD4 cells test. Data of CT manifestations （including scope of lesions, pathological morphology, and nature） and CIM cells was analyzed, and so was the relationship between the imaging findings and the level of CD4 cells in the observation group. Results In the observation group and the control group, there were 118 cases （86.1 %） and 69 cases （53.1 %） with lesions involving more than 3 lobes, respectively; and there were 84 cases （61.3%） and 26 cases （20.0%） with lesions involving the whole lung, respectively; the differences were statistically significant （X^2=34.73, 47.00, both P〈0.01）. The pathological morphology changes of the observation group and the control group were as follows： multiple disseminated nodules, 85 cases （62.0%） vs. 39 cases （30.0%）; mediastinal lymphadenopathy, 101 cases （73.7%） vs. 29 cases （22.3%） ; multiple cavities 96 cases （70. 1%） vs. 22 cases （16.9%） ; pleural thickening, 86 cases （62.8%） vs. 36 cases （27.7%）; focal proliferation, 90 cases （65.7%） vs. 35 cases （26.9%）; fibrosis, 75 cases （54.7%） vs. 28 cases （21.5%） ; destroyed lungs, 33 cases （24.1%） vs. 7 cases （5.4%） ; bronchiectasis, 95 cases （69.30%） vs. 22 cases （16.9%）; all the differences were statistically significant （X^2 =27.54, 62.85, 76.40, 33.08, 40.27, 31.04, 18.32 and 74. 46, respectively, all P〈0.05）. The average inner diameter of cavities in the observation group was significantly greater than that of the control group （（30.3±4.9） mm vs. （21.3±4.2） mm; t=10.19, P〈0.01）. The sizes of cavities in subgroups A, B, C of the observation group were （21.4±3.0） mm, （24.±3.4） mm and （30.7 ± 3.9） mm respectively, differences were statistically significant （F= 60.56, P〈 0.01）. Average number of CD4 cells was （425.6±156.5）μl in the observation group, lower than that of the control group （734.4±215.6）μl） （t= 13.45, P〈0.01）. Average number of CD4 cells of group A was （141.3± 38.5）/μl. Difference of average numbers of CD4 cells between groups B and B1 was statistically significant （（303.8±57.9.5）1 vs. （352.3±65.3）/μl, t=-3.53, P〈0.01）, and so was groups C and C1 （（603.8± 188.3）/μl vs. （852.5±231.4）/μl, t=-7.18, P〈0.01）. Conclusion Patients with muhbdrug resistant tuber- culosis having lower CD4 cells than those with tuberculosis sensitive to anti-tuberculosis drugs, their lesions were widely involved and multiple dissemination; furthmore, there were more multiple cavities, chronic courses and complications. CT manifestations shows relationship with CD4 cells to a certain extent.
出处
《中国防痨杂志》
CAS
2017年第6期597-603,共7页
Chinese Journal of Antituberculosis
