老年非结核分枝杆菌肺病的高分辨率CT表现

High-resolution CT findings of nontuberculous mycobacterial pulmonary disease in the elderly

摘要:

目的 探讨老年人非结核分枝杆菌肺病的高分辨率CT(HRCT)表现。方法 回顾性分析2017年1月至2020年1月北京老年医院经实验室检查确诊的非结核分枝杆菌(NTM)肺病患者65例,按照年龄分为2组:老年组(年龄≥60岁)31例,中青年组(年龄＜60岁)34例。总结分析31例老年组NTM肺病患者的一般资料及HRCT影像特征,同时对老年组和中青年组NTM肺病患者临床资料进行对照分析。采用SPSS 22.0 软件进行统计分析。计数资料采用例数(百分率)表示,组间比较采用χ²检验。结果 老年组31例NTM肺病患者中,男性20例(64.5%),病变累及5个肺叶22例(71.0%),支气管扩张26例(83.9%),条索影26例(83.9%),肺结节25例(80.6%),胸膜增厚16例(51.6%),肺内空洞14例(45.2%)。老年组NTM肺病患者男性数量明显少于中青年组,差异有统计学意义[20(64.5%)和29(85.3%),χ²=3.773,P=0.049]；老年组NTM肺病患者右肺中叶支气管扩张、全肺叶支气管扩张、肺内钙化灶、胸腔积液、纵膈淋巴结钙化或密度增高及肺间质纤维化发生情况分别为16例(51.6%)、6例(19.6%)、18例(58.1%)、11例(35.5%)、13例(41.9%)、5例(16.1%),均高于中青年组[7例(20.6%)、0例(0.0%)、10例(29.4%)、2例(5.9%)、5例(14.7%)、0例(0.0%)],差异有统计学意义(χ²=6.826、15.660、5.429、7.127、6.004、5.941；均P＜0.05)。结论 老年NTM肺病累及范围广,肺内表现多样,全肺叶支气管扩张为主要特征性表现,右肺中叶支气管扩张常见。

Abstract:

Objective To analyze the high-resolution CT (HRCT) findings of nontuberculous mycobacterial pulmonary disease (NTM-PD) in the elderly. Methods A retrospective analysis was made of laboratory-confirmed 65 NTM-PD cases in Beijing Geriatric Hospital from January 2017 to January 2020. The patients were divided into the elderly group (age ≥60 years; n=31) and the young and middle-age group (age <60 years; n=34). An analysis was done of the general information and HRCT features of the elderly group, and a comparison was made of the two groups. SPSS statistics 22.0 was used for statistical analysis. The numeration data were expressed as cases (percentage) and compared between the two groups using χ² test. Results Among the 31 elderly patients [male, 20 (64.5%)], five lobes affected were observed in 22 cases (71.0%), bronchiectasis in 26 cases (83.9%), strip shadow in 26 cases (83.9%), pulmonary nodules in 25 cases (80.6%), pleura thickening in 16 cases (51.6%), and pulmonary cavity in 14 cases (45.2%). The number of male patients in the elderly group was significantly less than that in the young and middle-aged group, the difference being statistically significant [20 (64.5%) and 29 (85.3%), χ²=3.773, P= 0.049]. The elderly group had higher incidences than the young and middle-aged group in bronchiectasis in right middle lobe[16 (51.6%) vs 7 (20.6%)], bronchiectasis in whole lobe[6 (19.6%) vs 0 (0.0%)], calcification in lung[18 (58.1%) vs 10 (29.4%)], pleural effusion[11 (35.5%) vs 2 (5.9%)], calcification or density increase of mediastinal lymph nodes[13 (41.9%) vs 5 (14.7%)] and pulmonary interstitial fibrosis[5 (16.1%) vs 0 (0.0%)]. The differences were statistically significant (χ²=6.826,15.660,5.429,7.127,6.004,5.941; all P<0.05). Conclusion NTM-PD in the elderly has a massive involvement and a wide range of manifestations in the lungs, with baro-nchiectasis of the whole lung as its main characteristic manifestation, and bronchiectasis is common in the middle lobe of the right lung.