CAJ | 학술논문

目的探讨急性粟粒性肺结核(AMPT)的CT表现特征及病理基础.方法回顾性分析25例AMPT的CT表现,并对人类免疫缺陷病毒(HIV)阳性和阴性组各种CT征象的发生率行双侧确切概率法χ2检验.HIV阴性组2例尸检全肺标本行冠状面HRCT扫描,并切割成10 mm厚度肺标本薄片,选取结节丰富区制作冠状面大切片(80～150 μm)和5 μm组织切片,将CT与病理所见进行对照观察;对其中1例HRCT和病理显示微结节在肺小叶的分布行x2检验.结果 25例AMPT患者中HIV 阳性11例,阴性14例.HRCT扫描发现所有AMPT患者两肺均随机分布着弥漫微结节,磨玻璃密度(GGO,17例)是主要的伴发征象.结节融合、肺实变仅出现在HIV阳性患者中(分别为5和6例),阴性患者无一例.分析2例尸检病例,结节以小叶中心与小叶周边之间肺组织分布最多(分别为792和560个),病理证实位于肺泡间隔;其中1例HRCT显示结节在肺小叶内的分布(1060个微结节)与病理所见(864个结节)差异无统计学意义(x2=2.814,P＞0.05).AMPT合并急性呼吸窘迫综合征(ARDS)于HRCT上表现为弥漫GGO,病理基础为肺水肿、炎症及肺泡透明膜.结论 AMPT的CT表现有一定特征,呈血行分布结节;肺内出现弥漫GGO需警惕合并ARDS.
목적 탐토급성속립성폐결핵(AMPT)적CT표현특정급병리기출.방법 회고성분석25례AMPT적CT표현,병대인류면역결함병독(HIV)양성화음성조각충CT정상적발생솔행쌍측학절개솔법χ2검험.HIV음성조2례시검전폐표본행관상면HRCT소묘,병절할성10 mm후도폐표본박편,선취결절봉부구제작관상면대절편(80～150 μm)화5 μm조직절편,장CT여병리소견진행대조관찰;대기중1례HRCT화병리현시미결절재폐소협적분포행x2검험.결과 25례AMPT환자중HIV 양성11례,음성14례.HRCT소묘발현소유AMPT환자량폐균수궤분포착미만미결절,마파리밀도(GGO,17례)시주요적반발정상.결절융합、폐실변부출현재HIV양성환자중(분별위5화6례),음성환자무일례.분석2례시검병례,결절이소협중심여소협주변지간폐조직분포최다(분별위792화560개),병리증실위우폐포간격;기중1례HRCT현시결절재폐소협내적분포(1060개미결절)여병리소견(864개결절)차이무통계학의의(x2=2.814,P＞0.05).AMPT합병급성호흡군박종합정(ARDS)우HRCT상표현위미만GGO,병리기출위폐수종、염증급폐포투명막.결론 AMPT적CT표현유일정특정,정혈행분포결절;폐내출현미만GGO수경척합병ARDS.
Objective To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact propability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV-seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients)was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules)and pathology(864 nodules) was not significantly difference(x2=2.814,P＞0.05). HRCT showed ground-glass opacities when ARDS occured, which were pulmonary edema,inflammation and hyaline membrane on alveolar wall pathologically. Conclusions The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT.