糖尿病肺结核与非糖尿病肺结核患者在抗结核治疗前后CT征象演变的对照研究

发布时间：2018-06-29 22:52

本文选题：肺结核 + 糖尿病　；参考：《大连医科大学》2012年硕士论文

【摘要】：目的：本研究对合并及未合并糖尿病的肺结核患者胸部CT表现进行比较分析，同时对两组患者在抗结核治疗前后的CT表现进行比较和评价。材料与方法：对71例活动期的继发性肺结核患者的胸部CT影像进行观察分析，其中41例患者无糖尿病史，30例患者合并糖尿病。所有患者均在抗结核治疗前后进行胸部CT检查。对两组患者及其抗结核治疗前后的CT表现进行对比分析。结果：41例非糖尿病患者中，有28例可观察到肺部实变征象，其中特征性的CT表现包括：肺段受累（98%），空洞（32%），树芽征（61%），支气管扩张（41%）。治疗前后相比较发现，树芽征和胸腔积液的消失以及纤维化病变的出现提示治疗有效。本组患者在治疗前有10例可观察到磨玻璃密度影，治疗3个月后有6例仍可见，6个月后仅2例可见。治疗前后均可观察到网状影（小叶内间质和小叶间隔增厚），间质结节和纤维化等征象。30例合并糖尿病的肺结核患者中，有23例可观察到肺部实变征象。而且病变不具备肺段受累（27%）的特点，可见多发小空洞形成（30%），树芽征（43%），支气管扩张（30%）。治疗前有5例患者可观察到磨玻璃密度影，治疗3个月后仍有5例可见，6个月后有3例可见。治疗前后均可观察到小叶中心结节，边界模糊结节，网状影（小叶内间质和小叶间隔增厚）、间质结节和纤维化等征象。发生于下叶基底段，上叶前段或右肺中叶等非典型部位的结核灶在两组患者的出现率相同。结论：合并糖尿病与非糖尿病的肺结核患者的胸部CT表现有所不同。合并糖尿病的患者中，结核灶不具备按肺段分布的特点，并且可见多发空洞形成。在随访观察中，空洞缩小,肺实变与树芽征吸收以及纤维化病变的出现提示抗结核治疗有效，但糖尿病性肺结核患者疗效不佳，病灶的吸收消散也较非糖尿病患者更慢。对于肺结核患者而言，约半数患者的痰检呈阴性，因此，CT可为肺结核的诊断和治疗，尤其是糖尿病肺结核的早期干预，提供十分有价值的信息。
[Abstract]:Objective: to compare and evaluate the chest CT findings of pulmonary tuberculosis patients with and without diabetes mellitus before and after anti-tuberculosis treatment. Materials and methods: the chest CT images of 71 cases of active secondary pulmonary tuberculosis were observed and analyzed. Among them 41 cases had no history of diabetes and 30 cases were complicated with diabetes. All patients underwent chest CT before and after anti-tuberculosis treatment. Ct findings of two groups of patients and their anti-tuberculosis before and after treatment were compared and analyzed. Results among 41 cases of non-diabetic patients, 28 cases could see pulmonary consolidation signs. The characteristic CT manifestations included lung segment involvement (98%), cavity (32%), tree bud sign (61%) and bronchiectasis (41%). It was found that the disappearance of tree bud sign, pleural effusion and fibrosis were effective before and after treatment. In this group, 10 cases could be observed before treatment, 6 cases were still visible after 3 months of treatment, and only 2 cases were visible after 6 months of treatment. Reticular shadow (interstitial and interlobular septal thickening), interstitial nodules and fibrosis were observed in 23 of 30 pulmonary tuberculosis patients with diabetes mellitus before and after treatment. The lesions did not have the characteristics of lung involvement (27%). Multiple cavitation formation (30%), tree bud sign (43%) and bronchiectasis (30%) were observed. Before treatment, 5 cases could be observed with optoglassy density, 5 cases were still visible after 3 months of treatment, and 3 cases were visible after 6 months of treatment. Central lobular nodule, blurred boundary nodule, reticular shadow (interlobular interstitial and interlobular septal thickening), interstitial nodule and fibrosis were observed before and after treatment. The incidence of tuberculous foci in the basal segment of the lower lobe, the anterior segment of the upper lobe or the middle lobe of the right lung was the same in the two groups. Conclusion: chest CT findings of pulmonary tuberculosis patients with diabetes and non-diabetes are different. In patients with diabetes, tuberculous foci are not characterized by pulmonary segment distribution, and multiple cavities can be seen. In the follow-up observation, the cavity shrank, the pulmonary consolidation, tree bud sign absorption and the appearance of fibrosis lesion indicated that anti-tuberculosis treatment was effective, but the curative effect of diabetic pulmonary tuberculosis patients was not good, and the absorption and dissipation of the focus was slower than that of non-diabetic patients. For patients with pulmonary tuberculosis, about half of them have negative sputum examination, so CT can provide valuable information for the diagnosis and treatment of pulmonary tuberculosis, especially for the early intervention of diabetic tuberculosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521;R816.41

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