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目的观察广泛耐药结核(XDR-TB)患者影像学特征及临床表现,提高对XDR-TB的认识。方法收集2013年11月至2015年11月长沙市中心医院、武汉市救治中心、丽水市中医院、福州肺科医院、衡阳市第三人民医院、郴州市第二人民医院6家结核病医院门诊及住院的XDR-TB患者80例,对其影像学表现及临床资料进行分析及讨论。结果 80例广泛耐药结核患者中,咳嗽、咳痰75例,呼吸困难66例,消瘦66例,乏力64例,盗汗44例,胸痛37例,发热35例,咯血30例,肺部湿啰音27例;曲霉菌感染5例,合并糖尿病5例;病灶分布在小于或等于2个肺野7例,3~5个肺野50例,侵犯全部肺野23例,合并空洞形成64例,毁损肺25例;采用不同方案治疗12个月后病灶明显吸收3例,吸收25例,不变24例,恶化28例。结论广泛耐药结核复杂多样、侵袭广泛的影像学特征决定了其严重多变的临床症状和极差的预后。
Objective To observe the imaging features and clinical manifestations of patients with XDR-TB and to improve the understanding of XDR-TB. Methods From November 2013 to November 2015, six TB hospitals in Changsha Central Hospital, Wuhan Rescue Center, Lishui Traditional Chinese Medicine Hospital, Fuzhou Pulmonary Hospital, Hengyang Third People’s Hospital and Chenzhou Second People’s Hospital were recruited. Eighty patients were hospitalized with XDR-TB, and their imaging findings and clinical data were analyzed and discussed. Results Among the 80 patients with extensive drug-resistant TB, 75 were cough and expectoration, 66 were dyspnea, 66 were wasting, 64 were fatigue, 44 were night sweats, 37 were chest pain, 35 were fever, 30 were hemoptysis, and the lungs were wet 27 cases of asymptomatic infection, 5 cases of Aspergillus infection and 5 cases of diabetes mellitus. The lesions were located in 7 cases with less than or equal to 2 lung fields, 50 cases with 3-5 lung fields, 23 cases with invasion of all lung fields, 25 cases of lung damage; using different programs for 12 months after the lesion was significantly absorbed in 3 cases, 25 cases of absorption, unchanged in 24 cases, worsening in 28 cases. Conclusions Extensive and multidrug resistant tuberculosis is a multidrug-resistant and extensively invasive imaging modality that determines its clinically significant and variable prognosis.