耐多药/广泛耐药肺结核不同中医证候的CT特征分析

doi:10.19983/j.issn.2096-8493.20210143

摘要/Abstract

摘要：

目的: 探讨耐多药/广泛耐药肺结核不同中医证候的CT影像特征,为肺结核中医辨证分型提供客观依据。方法: 收集2019 年7月至2020年12月广州市胸科医院确诊的耐多药肺结核患者37例、广泛耐药肺结核患者23例进行中医证候分型及CT影像学检查,分析中医证候与胸部CT影像特征之间的相关性。结果: 60例患者中,阴虚火旺证28例(46.67%),气阴两虚证24例(40.00%),阴阳两虚证6例(10.00%),肺阴亏虚证2例(3.33%)。60例患者单肺叶分布者2例(3.34%),2肺叶、3肺叶及4肺叶分布者各8例(13.33%),全肺叶分布者34例(56.67%)。阴虚火旺证中,单肺叶及2肺叶分布8例,3肺叶及4肺叶分布9例,全肺叶分布11例;肺阴亏虚证中,全肺叶分布2例,二者中医证候组间病灶在肺叶分布上差异有统计学意义(χ²=10.100,P=0.031)。并发肺部空洞36例,占总数的60.00%;空洞性病变中,肺阴亏虚证1例(2.78%),阴虚火旺证15例(41.67%),气阴两虚证14例(38.89%),阴阳两虚证6例(16.66%)。阴虚火旺证并发厚壁空洞4例,虫蚀样空洞3例,薄壁及虫蚀样空洞3例,厚壁、薄壁及虫蚀样空洞2例,薄壁空洞2例,厚壁及薄壁空洞1例;肺阴亏虚证并发厚壁及薄壁空洞1例,二者中医证候组间在并发空洞形态上差异有统计学意义(χ²=11.929,P=0.026)。阴虚火旺证中斑片影19例、小结节影17例、大结节影及条索影各15例、斑点影14例、片状影8例,片块影及树芽征分别为4例和3例;肺阴亏虚证中小结节、条索影、斑点影各为2例,斑片影及大结节各1例,二者中医证候组间在肺部病灶形态上差异有统计学意义(χ²=15.600,P=0.015)。结论: 耐多药/广泛耐药肺结核病灶分布广泛,多并发空洞,中医证候以阴虚火旺证、气阴两虚证多见。肺阴亏虚证与阴虚火旺证组间在肺部病灶分布、形态、并发空洞上有差异,对中医临床有一定的指导意义。

关键词: 中医证候, 结核,抗多种药物性, 结核,肺, 体层摄影术,X线计算机

Abstract:

Objective: To explore the CT features of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) patients with different Traditional Chinese Medicine (TCM) syndrome, to provide basis for TCM syndrome differentiation of tuberculosis patients. Methods: Thirty-seven MDR-TB patients and 23 XDR-TB cases diagnosed by Guangzhou Chest Hospital from July 2019 to December 2020 were studied with TCM Syndrome classification and CT examination. Correlation of TCM syndromes and chest CT image features was analyzed. Results: Among those 60 patients, 28 cases (46.67%) had Hyperactivity of Fire and Yin Deficiency (HFYD) syndrome, 24 cases (40.00%) had Deficiency of Qi and Yin (DQY) syndrome, 6 cases (10.00%) had Deficiency of Yin and Yang (DYY) syndrome, 2 cases (3.33%) had Pulmonary Yin Deficiency (PYD) syndrome. There were 2 cases (3.34%) with single lung lobe lesion, 8 cases (13.33%) with lesions in 2, 3 and 4 lung lobes for each, and 34 cases (56.67%) with lesions in all lung lobes. For patients with HFYD syndrome, there were 8 cases with single lobe lesion and 2 lobes, 9 cases with lesions in 3 lobes and 4 lobes, and 11 with lesions in all lung lobes; For patients with PYD syndrome, there were 2 cases with lesions in all lung lobes. There was significant differences in the distribution of lung lobes between those two TCM syndrome groups (χ²=10.100,P=0.031). Thirty-six cases (60.00%) had pulmonary cavities, among whom 1 case (2.78%) showed PYD, 15 cases (41.67%) showed HEYD, 14 cases (38.89%) showed DQY, and 6 cases (16.66%) showed DYY. For patients with HFYD syndrome, there were 4 cases having thick wall cavities, 3 cases having wormlike cavities, 3 cases having thin wall and wormlike cavities, 2 cases having thick wall, thin wall and wormlike cavities, 2 cases having thin wall cavities, 1 case having thick wall and wormlike cavities; One case with PYD syndrome had thick wall and thin wall cavities. There was significant differences in the shape of cavity between those two TCM Syndrome groups (χ²=11.929,P=0.026). For patients with HFYD syndrome, there were 19 cases having patch shadows, 17 cases having small nodule shadows, 15 cases having big nodule shadows, 15 cases having striate shadows, 14 cases having spot shadows, 8 cases having flaky shadows, 4 cases having block shadows and 3 cases having tree-bud sign. For patients with PYD syndrome, there were 2 cases having small nodule shadows, 2 cases having striate shadows, 1 case having patch shadows and 1 case having large nodule shadows, there was significant difference in pulmonary lesion morphology between those two TCM syndrome groups (χ²=15.600,P=0.015). Conclusion: Lesions of MDR-TB and XDR-TB were widely distributed in patient’ lungs and cavities were quite common. The TCM syndromes of HEYD and DQY were major TCM manifestations.There were significant differences in lung lesion distribution, morphology, cavity between the PYD syndrome and HFYD syndrome groups which could provide certain guidance for TCM clinical practice.

Key words: TCM syndrome, Tuberculosis,multidrug-resistant, Tuberculosis,pulmonary, Tomography,X-ray computer

中图分类号:

R521
R81

任会丽, 潘静洁, 张宏, 梁瑞云, 方伟军. 耐多药/广泛耐药肺结核不同中医证候的CT特征分析[J]. 结核与肺部疾病杂志, 2022, 3(1): 4-8. doi: 10.19983/j.issn.2096-8493.20210143

REN Hui-li, PAN Jing-jie, ZHANG Hong, LIANG Rui-run, FANG Wei-jun. CT features of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis patients with different Traditional Chinese Medicine syndromes[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(1): 4-8. doi: 10.19983/j.issn.2096-8493.20210143

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中医证型	例数	单肺叶 [例(构成比,%)]	2肺叶 [例(构成比,%)]	3肺叶 [例(构成比,%)]	4肺叶 [例(构成比,%)]	全肺叶 [例(构成比,%)]
肺阴亏虚	2	0(0/2)	0(0/2)	0(0/2)	0(0/2)	2(2/2)
阴虚火旺	28	2(7.14)	6(21.43)	5(17.86)	4(14.29)	11(39.28)
气阴两虚	24	0(0.00)	2(8.33)	3(12.50)	3(12.50)	16(66.67)
阴阳两虚	6	0(0/6)	0(0/6)	0(0/6)	1(1/6)	5(5/6)

中医证型	合并空洞例数	厚壁空洞 [例(构成比,%)]	薄壁空洞 [例(构成比,%)]	虫蚀样空洞 [例(构成比,%)]	厚壁及薄壁空洞 [例(构成比,%)]	厚壁及虫蚀样空洞 [例(构成比,%)]	薄壁及虫蚀样空洞 [例(构成比,%)]	厚壁、薄壁及虫蚀样空洞 [例(构成比,%)]
肺阴亏虚	1	0(0/1)	0(0/1)	0(0/1)	1(1/1)	0(0/1)	0(0/1)	0(0/1)
阴虚火旺	15	4(26.67)	2(13.33)	3(20.00)	1(6.67)	0(0.00)	3(20.00)	2(13.33)
气阴两虚	14	5(35.71)	3(21.43)	2(14.29)	0(0.00)	1(7.14)	1(7.14)	2(14.29)
阴阳两虚	6	0(0/6)	2(2/6)	0(0/6)	1(1/6)	3(3/6)	0(0/6)	0(0/6)

中医证候	例数	斑点影 [例(率, %)]	斑片影 [例(率, %)]	片状影 [例(率, %)]	小结节影 [例(率, %)]	大结节影 [例(率, %)]	条索影 [例(率, %)]	网格影 [例(率, %)]	实变影 [例(率, %)]	片块影 [例(率, %)]	树芽征 [例(率, %)]
阴虚火旺	28	14(50.00)	19(67.86)	8(28.57)	17(60.71)	15(53.57)	15(53.57)	0(0.00)	0(0.00)	4(14.29)	3(10.71)
气阴两虚	24	14(58.33)	15(62.50)	5(20.83)	15(62.50)	8(33.33)	14(58.33)	1(4.17)	1(4.17)	3(12.50)	0(0.00)
阴阳两虚	6	4(4/6)	6(6/6)	2(2/6)	3(3/6)	1(1/6)	5(5/6)	0(0/6)	0(0/6)	0(0/6)	0(0/6)
肺阴亏虚	2	2(2/2)	1(1/2)	0(0/2)	2(2/2)	1(1/2)	2(2/2)	0(0/2)	0(0/2)	0(0/2)	0(0/2)