成人肺结核合并其他肺部感染的CT影像特征及病原学特点分析

CT imaging and pathological characteristics of adult pulmonary tuberculosis complicated by other pulmonary infections

摘要:

目的 分析成人肺结核合并其他肺部感染的CT特征及病原学特点。方法 选取2021年1月—2023年7月在安徽省胸科医院确诊为肺结核患者196例，其中，98例合并肺部感染为感染组，98例无肺部感染为无感染组。整理患者的临床资料，总结合并肺部感染患者的临床特点和CT影像学表现；采集患者痰液或气管镜灌洗液标本，采用平板划线法分离病原菌，药敏试验分析其耐药性。结果 患者主要临床表现为咳嗽、咳痰；感染组合并低蛋白血症、咳痰、气喘和肺部啰音发生率均高于无感染组（P <0.05）；感染组血白细胞、中性粒细胞、C反应蛋白高于无感染组（P <0.05）。患者病灶均好发于两肺上叶尖后段及下叶背段，CT表现多为结节影和斑点；感染组病灶累及多个肺段、多个肺叶及双侧肺、实变影发生率均高于无感染组（P <0.05），纵隔淋巴结增大和胸腔积液发生率均低于无感染组（P <0.05）。肺结核合并肺部感染者的病原菌以革兰阴性菌为主（88.78%），包括肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌等，且大多数为耐药菌。结论 成人肺结核合并其他肺部感染患者缺乏特异性临床表现，但其病灶分布范围更广，病原菌分布复杂，耐药严重，患者原有症状加重时应加强评估，提高肺部感染的诊治水平。

Abstract:

Objective To analyze the CT imaging features and pathological characteristics of adult pulmonary tuberculosis (TB) complicated by other pulmonary infections.Methods A total of 196 patients diagnosed with pulmonary TB at Anhui Chest Hospital from January 2021 to July 2023 were included in this study. Among them, 98 patients with concurrent pulmonary infections formed the infection group, and 98 patients without pulmonary infections formed the non-infection group. Clinical data were organized to summarize the clinical features and CT imaging presentations of patients with coexisting pulmonary infections. Sputum or bronchial lavage fluid samples were collected for bacterial isolation using the streak plate method, and drug susceptibility testing was performed to analyze resistance patterns.Results The primary clinical symptoms were coughing and expectoration. The infection group showed higher rates of hypoalbuminemia, productive cough, wheezing, and pulmonary rales compared to the non-infection group (P < 0.05). Elevated levels of white blood cells, neutrophils, and C-reactive protein were observed in the infection group (P < 0.05). Lesions predominantly appeared in the apical posterior segments of the upper lobes and the dorsal segments of the lower lobes. CT images typically showed nodular shadows and patchy opacities. The infection group had more widespread involvement across multiple pulmonary segments and lobes, bilateral lungs, and a higher incidence of consolidation compared to the non-infection group (P < 0.05). Enlarged mediastinal lymph nodes and pleural effusion were less common in the infection group (P < 0.05). The predominant pathogens in patients with pulmonary TB complicated by infections were Gram-negative bacteria (88.78%), including Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, with most exhibiting drug resistance.Conclusion Adults with pulmonary TB complicated by other pulmonary infections lack specific clinical presentations but have broader lesion distribution, complex pathogen profiles, and severe drug resistance. An exacerbation of symptoms should prompt enhanced assessment and improved management of pulmonary infections.