Panda Ananya, Bhalla Ashu Seith, Sharma Raju, Mohan Anant, Sreenivas Vishnu, Kalaimannan Umasankar, Upadhyay Ashish Dutt
Department of Radiodiagnosis, All Institute of Medical Sciences, New Delhi, India.
Department of Pulmonary Medicine, All Institute of Medical Sciences, New Delhi, India.
Lung India. 2016 Nov-Dec;33(6):592-599. doi: 10.4103/0970-2113.192871.
To study the correlation between dyspnea, radiological findings, and pulmonary function tests (PFTs) in patients with sequelae of pulmonary tuberculosis (TB).
Clinical history, chest computed tomography (CT), and PFT of patients with post-TB sequelae were recorded. Dyspnea was graded according to the Modified Medical Research Council (mMRC) scale. CT scans were analyzed for fibrosis, cavitation, bronchiectasis, consolidation, nodules, and aspergilloma. Semi-quantitative analysis was done for these abnormalities. Scores were added to obtain a total morphological score (TMS). The lungs were also divided into three zones and scores added to obtain the total lung score (TLS). Spirometry was done for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV), and FEV/FVC.
Dyspnea was present in 58/101 patients. A total of 22/58 patients had mMRC Grade 1, and 17/58 patients had Grades 2 and 3 dyspnea each. There was a significant difference in median fibrosis, bronchiectasis, nodules ( < 0.01) scores, TMS, and TLS ( < 0.0001) between dyspnea and nondyspnea groups. Significant correlations were obtained between grades of dyspnea and fibrosis ( = 0.34, = 0.006), bronchiectasis ( = 0.35, = 0.004), nodule ( = 0.24, = 0.016) scores, TMS ( = 0.398, = 0.000), and TLS ( = 0.35, = 0.0003). PFTs were impaired in 78/101 (77.2%) patients. Restrictive defect was most common in 39.6% followed by mixed in 34.7%. There was a negative but statistically insignificant trend between PFT and fibrosis, bronchiectasis, nodule scores, TMS, and TLS. However, there were significant differences in median fibrosis, cavitation, and bronchiectasis scores in patients with normal, mild to moderate, and severe respiratory defects. No difference was seen in TMS and TLS according to the severity of the respiratory defect.
Both fibrosis and bronchiectasis correlated with dyspnea and with PFT. However, this correlation was not linear. The overall extent of radiological abnormalities correlated only with dyspnea but not with PFT.
研究肺结核后遗症患者呼吸困难、影像学表现与肺功能测试（PFT）之间的相关性。
记录肺结核后遗症患者的临床病史、胸部计算机断层扫描（CT）及PFT结果。根据改良医学研究委员会（mMRC）量表对呼吸困难进行分级。对CT扫描结果分析纤维化、空洞形成、支气管扩张、实变、结节及曲菌球情况。对这些异常进行半定量分析。将各项分数相加得到总形态学评分（TMS）。肺部还分为三个区域，将各区域分数相加得到全肺评分（TLS）。进行肺量计检测以获取用力肺活量（FVC）、第1秒用力呼气量（FEV）及FEV/FVC。
101例患者中有58例存在呼吸困难。58例呼吸困难患者中，22例为mMRC 1级，17例为2级和3级呼吸困难。呼吸困难组与无呼吸困难组在纤维化、支气管扩张、结节（<0.01）评分、TMS及TLS（<0.0001）的中位数上存在显著差异。呼吸困难分级与纤维化（=0.34，=0.006）、支气管扩张（=0.35，=0.004）、结节（=0.24，=0.016）评分、TMS（=0.398，=0.000）及TLS（=0.35，=0.0003）之间存在显著相关性。101例（77.2%）患者肺功能受损。限制性缺陷最为常见，占39.6%，其次是混合性缺陷，占34.7%。PFT与纤维化、支气管扩张、结节评分、TMS及TLS之间呈负相关，但无统计学意义。然而，在呼吸功能正常、轻度至中度及重度缺陷患者中，纤维化、空洞形成及支气管扩张评分的中位数存在显著差异。根据呼吸功能缺陷的严重程度，TMS及TLS未见差异。
纤维化和支气管扩张均与呼吸困难及PFT相关。然而，这种相关性并非线性。影像学异常的总体程度仅与呼吸困难相关，而与PFT无关。
