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抗结核治疗后感染马红球菌与脓肿分枝杆菌肺病的 CT 表现对比

Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy.

机构信息

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

出版信息

Radiology. 2012 Apr;263(1):260-70. doi: 10.1148/radiol.12111374. Epub 2012 Feb 27.

Abstract

PURPOSE

To present the serial computed tomographic (CT) findings of lung abnormalities in Mycobacterium massiliense pulmonary disease compared with those in Mycobacterium abscessus disease.

MATERIALS AND METHODS

The institutional review board approved this retrospective study and waived informed consent. Serial chest CT scans of M massiliense (n = 34) and M abscessus (n = 24) pulmonary diseases were retrospectively reviewed. Patients were treated with clarithromycin-containing combination antibiotics regimen, and sputum examinations were performed regularly. CT scans were obtained at the beginning of antibiotic therapy, at the end of 4-week hospitalization, and at the time of 12-month antibiotic therapy.

RESULTS

All patients with M massiliense disease had sputum conversion during treatment, whereas 50% of patients with M abscessus disease had sputum conversion. The most common CT findings of M massiliense disease at presentation were cellular bronchiolitis (n = 34, 100%), bronchiectasis (n = 34, 100%), consolidation (n = 33, 97%), nodules (n = 32, 94%), and cavities (n = 15, 44%). These findings were similar in M abscessus disease. Thirty (88%) patients with M massiliense disease had decrease in overall CT score at 12-month therapy, whereas only eight (33%) patients with M abscessus disease had a decrease (P < .0001). Improvement was noticeable in cellular bronchiolitis and cavity in M massiliense disease.

CONCLUSION

Common CT findings of M massiliense diseases overlap with those of M abscessus disease. However, responses to antibiotic treatment are much different; in M massiliense disease, negative sputum conversion is accomplished in all patients and serial CT scans show improvement in most patients.

摘要

目的

与脓肿分枝杆菌病相比,呈现分枝杆菌马萨里塞肺病的肺部异常连续计算机断层扫描(CT)表现。

材料与方法

该回顾性研究经机构审查委员会批准,并豁免了知情同意。回顾性分析了 34 例马萨里塞分枝杆菌和 24 例脓肿分枝杆菌肺病的连续胸部 CT 扫描。患者接受含克拉霉素的联合抗生素治疗方案治疗,定期进行痰检。CT 扫描分别在抗生素治疗开始时、4 周住院结束时和 12 个月抗生素治疗时进行。

结果

所有马萨里塞分枝杆菌病患者在治疗期间均发生痰培养转化,而脓肿分枝杆菌病患者中仅有 50%发生痰培养转化。马萨里塞分枝杆菌病的最常见 CT 表现为细胞性细支气管炎(n=34,100%)、支气管扩张(n=34,100%)、实变(n=33,97%)、结节(n=32,94%)和空洞(n=15,44%)。这些表现与脓肿分枝杆菌病相似。30 例(88%)马萨里塞分枝杆菌病患者在 12 个月治疗时的总 CT 评分下降,而脓肿分枝杆菌病患者中仅有 8 例(33%)评分下降(P<.0001)。马萨里塞分枝杆菌病患者的细胞性细支气管炎和空洞有明显改善。

结论

马萨里塞分枝杆菌病的常见 CT 表现与脓肿分枝杆菌病重叠。然而,抗生素治疗的反应却大不相同;在马萨里塞分枝杆菌病中,所有患者的痰培养均转为阴性,且连续 CT 扫描显示大多数患者均有改善。

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