探讨应用 X 线诊断肺结核与尘肺病的临床鉴别与影像学表现

摘要

目的：：探讨应用 X 线诊断肺结核与尘肺病的影像学表现以及临床鉴别价值。方法：选取疾控所2013年7月-2014年7月诊断的尘肺病患者42例作为尘肺组,以同期疾控所诊断的45例肺结核患者作为结核组,并将40例尘肺病合并肺结核患者作为对照组。分别对三组病例的 X 线诊断情况进行回顾性分析,总结不同患者的 X 线影像表现,并探讨 X 线在疾病间的鉴别诊断价值。结果：Ⅱ期尘肺病患者与急性粟粒型肺结核患者的 X 线胸片中均存在双侧肺野小结节影,Ⅲ期尘肺病合并结核病患者与继发型肺结核患者的 X 线胸片中均存在斑块影或长条影,其影像表现较为相似。与血行播散型肺结核患者比较,尘肺病患者的 X 线结节表现中具有大小、分布与密度不均匀特征；与继发型肺结核伴空洞患者比较,尘肺病伴空洞患者具有厚壁空洞、空洞直径偏小及无卫星灶等特征,其差异比较均存在统计学意义(P 均<0.05)。结论：尘肺病与肺结核的 X 线影响表现中具有一定的相似性,但通过胸片全面观察与综合分析也可存在显著差异表现,必要时良好结合粉尘接触史与痰液培养实验充分避免误诊情况的发生。%Objective:Analysis of imaging findings and differential diagnosis value of X-ray between tuberculosis and pneumoconiosis.Methods:Selected 42 patients with pneumoconiosis in the CDC from July 2013 to July 2014 as pneumo-coniosis group.45 patients with tuberculosis in the same period as tuberculosis group,40 patients with tuberculosis and pneumoconiosis as control group.Through retrospective analysis the X-ray performance of three to summarized the dif-ferential diagnosis value.Results:The chest X-ray film of phaseⅡpneumoconiosis and acute miliary tuberculosis all exis-ted small nodules of bilateral lung fields,and phase Ⅲ pneumoconiosis with tuberculosis and pulmonary tuberculosis all existed patchy shadow or streaks shadow.The nodule size,distribution and density in pneumoconiosis had uneven fea-ture compared with disseminated tuberculosis.The patients of pneumoconiosis with cavity showed that thick wall cavi-ty,small diameter cavity and without satellite lesion.The differences between groups had statistical significance(P <0.05).Conclusion:The performance of X-rays has similarity between pneumoconiosis and tuberculosis.But through comprehensive analysis also can reflect significant differences.