本文選題：肺結(jié)核 + 糖尿病��； 參考：《大連醫(yī)科大學》2012年碩士論文

【摘要】：目的：本研究對合并及未合并糖尿病的肺結(jié)核患者胸部CT表現(xiàn)進行比較分析，同時對兩組患者在抗結(jié)核治療前后的CT表現(xiàn)進行比較和評價。 材料與方法：對71例活動期的繼發(fā)性肺結(jié)核患者的胸部CT影像進行觀察分析，其中41例患者無糖尿病史，30例患者合并糖尿病。所有患者均在抗結(jié)核治療前后進行胸部CT檢查。對兩組患者及其抗結(jié)核治療前后的CT表現(xiàn)進行對比分析。 結(jié)果：41例非糖尿病患者中，有28例可觀察到肺部實變征象，其中特征性的CT表現(xiàn)包括：肺段受累（98%），空洞（32%），樹芽征（61%），支氣管擴張（41%）。治療前后相比較發(fā)現(xiàn)，樹芽征和胸腔積液的消失以及纖維化病變的出現(xiàn)提示治療有效。本組患者在治療前有10例可觀察到磨玻璃密度影，治療3個月后有6例仍可見，6個月后僅2例可見。治療前后均可觀察到網(wǎng)狀影（小葉內(nèi)間質(zhì)和小葉間隔增厚），間質(zhì)結(jié)節(jié)和纖維化等征象。30例合并糖尿病的肺結(jié)核患者中，有23例可觀察到肺部實變征象。而且病變不具備肺段受累（27%）的特點，可見多發(fā)小空洞形成（30%），樹芽征（43%），支氣管擴張（30%）。治療前有5例患者可觀察到磨玻璃密度影，治療3個月后仍有5例可見，6個月后有3例可見。治療前后均可觀察到小葉中心結(jié)節(jié)，邊界模糊結(jié)節(jié)，網(wǎng)狀影（小葉內(nèi)間質(zhì)和小葉間隔增厚）、間質(zhì)結(jié)節(jié)和纖維化等征象。發(fā)生于下葉基底段，上葉前段或右肺中葉等非典型部位的結(jié)核灶在兩組患者的出現(xiàn)率相同。 結(jié)論：合并糖尿病與非糖尿病的肺結(jié)核患者的胸部CT表現(xiàn)有所不同。合并糖尿病的患者中，結(jié)核灶不具備按肺段分布的特點，并且可見多發(fā)空洞形成。在隨訪觀察中，空洞縮小,肺實變與樹芽征吸收以及纖維化病變的出現(xiàn)提示抗結(jié)核治療有效，但糖尿病性肺結(jié)核患者療效不佳，病灶的吸收消散也較非糖尿病患者更慢。對于肺結(jié)核患者而言，約半數(shù)患者的痰檢呈陰性，因此，CT可為肺結(jié)核的診斷和治療，尤其是糖尿病肺結(jié)核的早期干預，提供十分有價值的信息。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R521;R816.41

【參考文獻】

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1 C. Perez-Guzman,A. Torres-Cruz,H. Villarreal-Velarde,M. A. Salazar-Lezama,M. H. Vargas,安燕生;192例糖尿病肺結(jié)核患者的不典型X線影像:一項比較性研究[J];結(jié)核與肺部疾病雜志(中文版);2001年03期

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