Qi Min, Li Pei-Jun, Wang Ye, Liang Zong-An
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
Open Med (Wars). 2021 Oct 27;16(1):1608-1615. doi: 10.1515/med-2021-0349. eCollection 2021.
The aim of this study is to investigate clinical features of atypical pulmonary tuberculosis (aPTB) mimicking bacterial pneumonia, determine imaging features with the highest degree of correlation, and identify predictors for acid-fast bacilli (AFB) positivity.
The clinical data of 259 patients considered as aPTB were retrospectively analyzed. The correlation of CT patterns was evaluated with Spearman analysis, and the predictors for AFB positivity were assessed with the multivariate analysis.
The most common symptom of aPTB was cough (84.6%), followed by fever and anorexia (47.1 and 41.7%, respectively). Infiltrated patchy was the most common radiological pattern (84.9%), followed by nodules (3-10 mm), micronodules (<3 mm), and consolidation (79.2, 78.8, and 66.0%, respectively). Nodules (3-10 mm) and micronodules ( = 0.988, < 0.001), consolidation and air bronchogram ( = 0.590, < 0.001), and pulmonary atelectasis and consolidation ( = 0.323, < 0.001) showed high correlation. In the multivariate analysis, hyperpyrexia (OR, 2.29; 95% CI, 1.22-4.29) and bronchiectasis (OR, 2.06; 95% CI, 1.04-4.06) were the predictors of AFB-smear positivity, while bulla (OR, 0.22; 95% CI, 0.05-0.97) was the predictor of AFB-smear negativity.
This study demonstrated the clinical and radiological features of aPTB mimicking pneumonia. Several paired radiological findings may guide us to the diagnosis of aPTB. Hyperpyrexia and bronchiectasis may be helpful for predicting AFB positivity, and bulla may be a predictive sign of AFB negativity.
本研究旨在调查模仿细菌性肺炎的非典型肺结核（aPTB）的临床特征，确定相关性最高的影像学特征，并识别抗酸杆菌（AFB）阳性的预测因素。
回顾性分析259例被视为aPTB患者的临床资料。采用Spearman分析评估CT模式的相关性，采用多因素分析评估AFB阳性的预测因素。
aPTB最常见的症状是咳嗽（84.6%），其次是发热和食欲不振（分别为47.1%和41.7%）。浸润性斑片是最常见的放射学模式（84.9%），其次是结节（3 - 10毫米）、微结节（<3毫米）和实变（分别为79.2%、78.8%和66.0%）。结节（3 - 10毫米）与微结节（r = 0.988，P < 0.001）、实变与空气支气管征（r = 0.590，P < 0.001）以及肺不张与实变（r = 0.323，P < 0.001）显示出高度相关性。在多因素分析中，高热（OR，2.29；95%CI，1.22 - 4.29）和支气管扩张（OR，2.06；95%CI，1.04 - 4.06）是AFB涂片阳性的预测因素，而肺大泡（OR，0.22；95%CI，0.05 - 0.97）是AFB涂片阴性的预测因素。
本研究展示了模仿肺炎的aPTB的临床和放射学特征。几对放射学表现可能有助于指导aPTB的诊断。高热和支气管扩张可能有助于预测AFB阳性，而肺大泡可能是AFB阴性的预测征象。
