摘要
目的探讨免疫功能低下患者并发肺结核的影像学特征,包括糖尿病、系统性红斑狼疮(SLE)、类风湿关节炎(RA)、皮肌炎。方法回顾性分析并发肺结核的82例糖尿病患者、17例SLE患者、17例RA患者、5例皮肌炎患者的胸部X线和CT表现,并与120例单纯肺结核患者对照。结果与单纯肺结核相比,糖尿病肺结核病灶多发生在非结核好发部位(P<0.01),多表现为干酪性坏死与空洞样病变(P<0.01),病灶多呈支气管播散(P<0.01),而纤维增殖灶少见(P<0.01)。SLE、RA、皮肌炎长期应用激素肺结核表现为粟粒状阴影的明显多见(P<0.01),其中不均匀性粟粒状阴影更是其特征性影像表现,单纯肺结核组未曾见到。两者差异有统计学意义。结论免疫功能低下患者并发肺结核与单纯肺结核在影像学表现上有明显差别,应引起临床医师在诊断、鉴别诊断上的高度重视。
Objective To evaluate the radiological features of pulmonary tuberculosis （PTB） in immunocompromised patients which include of diabetic patients, patients with systemic lupus erythematosus（ SLE）, rheu- matoid arthritis（RA） and dermatomyositis. Methods Retrospective analysis were done on CT scans and X -my features of PTB cases combined with diabetes mellitus （82） , SLE（17）, RA （17） , and dermatomyositis（5）, which were compared with pure PTB patients （120）. Results Compared with pure PTB patients, immunocompromised patients with PTB were different in imaging findings. In diabetic patients, the focus occurred more often in the pulmonary segments which were not the predisposed site of pure PTB（ P 〈 0.01 ）, and the diabetic patients with PTB had more caseous necrosis focus （P 〈 0.01 ）, more multiple cavities （ P 〈 0.01 ）, more bronchi disseminate focus （ P 〈 0.01 ） ,yet less fibrillose prolife - ration focus（ P 〈 0.01 ）. In the cases of SLE, RA and dermatomyositis patients with PTB, miliary focus was more often seen（P 〈 0.01 ）. Inhomogeneous miliary focus that had never been seen in pure PTB patients was the character of these cases. All these imaging features were statistically different. Conclusion The radiological features of PTB in immunocompromised patients are much different from that in pure PTB patients, which may be helpful for the clinicians to make the diagnosis and differential diagnosis of PTB in immunocompromised patients.
出处
《海南医学》
CAS
2010年第7期29-31,共3页
Hainan Medical Journal
