141例孤立性肺结核结节影像及临床资料表现分析

Imaging and Clinical Data Correlation Analysis of 141 Cases of Isolated Pulmonary Tuberculosis Nodules

摘要: 目的：通过对141例手术切除的不典型孤立性肺结核结节患者的胸部CT影像学特征及临床资料的回顾性分析，提高结核病高发地区对不典型肺结核结节诊断的准确率。方法：回顾性分析2019年12月~2023年4月新疆维吾尔自治区人民医院胸外科手术切除的858例孤立性肺结节中的141例不典型结核患者的胸部CT影像表现、临床症状及基本资料。结果：141例患者中表现为：肺结节大小(14.27 ± 4.76) mm；纯磨玻璃结节型62例(44.0%)、混杂结节型63例(44.7%)、实性结节型16例(11.4%)，影像学结节分类为单纯描述者96例(68.10%)；血沉增快43例(30.5%)、C反应蛋白阳性119例(84.30%)、T-SPOT阳性87例(61.70%)；所有结节均经手术取得组织病理，病理报告提示为肉芽肿性病变伴大片干酪样坏死，形态学符合结核，病理标本经抗酸染色阳性而诊断13例(9.2%)。结论：新疆作为结核病高发地区，孤立性肺结核结节发病率较其他地区更高，孤立性肺结核结节影像表现和孤立性恶性结节难以鉴别，需综合ESR、CRP、T-SPOT和胸部CT报告资料结果进行评估，若结节未明确增大或其它恶变倾向，可以考虑可定期随访，暂缓手术，以降低手术切除孤立性肺结节结核占比，以提高新疆地区肺结节的精准诊疗水平。

Abstract: Objective: In order to improve the accuracy of diagnosis of atypical pulmonary TB nodules in areas with high incidence of TB, we analyzed the chest CT imaging features and clinical data of 141 surgi-cally removed patients with atypical isolated pulmonary tuberculosis nodules. Method: A retro-spective analysis of the chest CT imaging features and clinical data of 141 patients with atypical sol-itary tuberculosis nodules who had undergone surgical in the People’s Hospital of Xinjiang Uygur Autonomous Region from December 2019 to April 2023. Result: Among the 141 patients, the size of pulmonary nodules was (14.27 ± 4.76) mm, 62 (44.0%) were pure ground-glass nodules, 63 (44.7%) were mixed nodules, 16 (11.4%) were solid nodules, 96 (68.10%) were classified as simple nodules by imaging, 43 (30.5%) were rapidly cyresen, 119 (84.30%) were positive for C-reactive protein, and 87 (61.70%) were positive for T-SPOT. All nodules were obtained by surgery for histo-pathology, and the pathology report showed that the lesions were granulomatous lesions with large pieces of caseous necrosis. The morphology was consistent with tuberculosis, and 13 cases (9.2%) were diagnosed after positive acid-fast staining of pathological specimens. Conclusion: As an area with a high incidence of tuberculosis, the incidence of solitary pulmonary tuberculosis nodules is higher than rest of China. It is difficult to distinguish the imaging manifestations of solitary pulmo-nary tuberculosis nodules from solitary malignant nodules, so it is necessary to evaluate the results of ESR, CRP, T-SPOT and chest CT report data. If the nodule doesn’t have a clear enlargement or other malignant tendency, regular follow-up and postponement of surgery can be considered to re-duce the proportion of solitary pulmonary tuberculosis nodules to be surgically removed.