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目的:综合分析基于胸部CT和实验室多项检查对于涂阴老年不典型肺结核的诊断研究。方法:收集2014年11月至2016年3月中山市第二人民医院影像诊断为老年不典型肺结核的75例患者的临床资料,观察CT征象及检出率的差异、实验室检查阳性率、治疗效果,分为诊断明确的涂阴不典型肺结核患者46例,不典型肺炎患者29例,筛选对于涂阴老年不典型肺结核有价值的CT征象。结果:(1)CT影像学表现:大片状肺实变影35例、磨玻璃斑片影46例、间质改变斑片影47例,单发块影15例,多发结节及块影20例,树芽征56例,空洞20例,总检出率依次分别为:46.7%、61.3%、62.7%、20%、26.7%、74.7%、26.7%;涂阴不典型肺结核组中磨玻璃斑片影、肺间质改变斑片影、树芽征的各检出率显著高于不典型肺炎组,差异具有统计学意义(P<0.05)。(3)实验室检查:PPD、结核抗体、血沉在涂阴不典型肺结核组的阳性率依次为:39.1%、76.1%、89.1%,不同程度显著高于不典型肺炎组,差异具有统计学意义(P<0.05)。结论:部分CT征象的检出率具有统计学意义,临床上难以诊断时,需重视影像学特点,有助于涂阴老年不典型肺结核的临床诊断。
OBJECTIVE: To comprehensively analyze the diagnosis of atypical tuberculosis of the aged with smear based on chest CT and laboratory tests. Methods: The clinical data of 75 patients diagnosed as elderly atypical pulmonary tuberculosis from the Second People’s Hospital of Zhongshan in November 2014 to March 2016 were collected. The differences of CT signs and detection rates, the positive rate of laboratory tests, The results were divided into 46 cases of atypical pulmonary tuberculosis with definite diagnosis and 29 cases of atypical pneumonia, and valuable CT signs of atypical tuberculosis of smear-negative elderly were screened. Results: (1) CT imaging findings: 35 cases of large patchy lung consolidation, 46 cases of ground glass patch, 47 cases of interstitial patch changes, 15 cases of single block, multiple nodules and block 20, 26.7%, 74.7%, 26.7% respectively. The total detection rate was 46.7%, 61.3%, 62.7%, 26.7%, 26.7% The detection rate of glass patch, patchy interstitial patch and tree buds were significantly higher than those of atypical pneumonia group (P <0.05). (3) Laboratory examination: The positive rates of PPD, TB antibody and ESR in smear negative atypical pulmonary tuberculosis were 39.1%, 76.1% and 89.1%, respectively, which were significantly higher than those in atypical pneumonia group (P <0.05). Conclusion: The detection rate of some CT signs is statistically significant. If it is difficult to diagnose clinically, it is necessary to pay attention to the imaging features and contribute to the clinical diagnosis of atypical pulmonary tuberculosis.