与耐多药肺结核相关的放射学征象的文献分析
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摘要
背景尽管肺药物敏感结核(DS-TB)和耐多药结核(MDR-TB)的诊断需要微生物检查证实,但胸部影像学早期识别可疑MDR-TB可以对诊断过程提供指引。本文对文献资料中与MDR-TB相关的放射学征象进行分析。方法于2018年1月29日搜索PubMed数据库,搜索关键字组合为"((extensive drug resistant tuberculosis)OR(multidrug-resistant tuberculosis))AND(CT or radiograph or imaging or X-ray or computed tomography)",并分析了报道DS-TB和MDR-TB放射学征象的英文文献。结果我们发现和分析了与分析目的有充分相关性的17篇文章。我们将报告的肺MDR-TB病例分为四个类别:(1)之前治疗过(继发或获得性)的HIV阴性成人MDRTB;(2)新发(或原发)HIV阴性成人MDR-TB;(3)HIV阳性成人MDR-TB;(4)儿童MDR-TB。肺MDR-TB的常见放射学表现包括:小叶中央小结节、分枝状线征和结节影(树芽征)、斑块或叶实变、空洞和支气管扩张。虽然总体上MDR-TB病例倾向病变更广泛、更容易双侧发病、胸膜受累、支气管扩张,及肺体积缩小;但仅依据这些征象难以作出MDR-TB的鉴别诊断。迄今的文献提示,肺MDR-TB特异性较高的放射学征象是厚壁多发空洞病变(特别是空洞≥3个时),虽然可能其敏感性不高。对于成人HIV阴性患者,与继发MDR-TB一致,新发MDR-TB也往往有较高的空洞病变发生率,估计在70%左右。结论厚壁多发空洞病变是提示MDR-TB诊断最有意义的放射学征象。未来的研究应该细致地量化空洞病变形态特征。
引文
[1]World Health Organization.Global tuberculosis report2018[EB/OL].[2018-09-18].Available online:http://www.who.int/tb/publications/global_report/en/.
[2]Chiang CY,Centis R,Migliori G B.Dru gresistanttuberculosis:past,present,future[J].Respirology,2010,15(3):413-432.
[3]Raviglione MC,Smith IM.XDR tuberculosis-implications for global public health[J].N Engl J Med,2007,356(7):656-659.
[4]Aziz MA,Wright A,Laszlo A,et al.WHO/International Union Against Tuberculosis And Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance.Epidemiology of antituberculosis drug resistance(the Global Project on Anti-tuberculosis Drug Resistance Surveillance):an updated analysis[J].Lancet,2006,368:2142-2154.
[5]World Health Organization.Global tuberculosis report.2014[EB/OL].[2015-01-21].Available online:http://www.who.int/tb/publications/global_report/en/.
[6]Orenstein EW,Basu S,Shah NS,et al.Treatment outcomes among patients with multidrug-resistant tuberculosis:systematic review and meta-analysis[J].Lancet Infect Dis,2009,9(3):153-161.
[7]Ahuja SD,Ashkin D,Avendano M,et al.Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB.Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes:an individual patient data meta-analysis of 9,153 patients[J].PLoSMed,2012,9:e1001300.
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[9]World Health Organization.The use of delamanid in the treatment of multidrug-resistant tuberculosis:interim policy guidance[EB/OL].[2014-05-22].Available online:http://apps.who.int/iris/bitstream/10665/137334/1/WHO_HTM_TB_2014.23_eng.pdf
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[25]Kim SH,Min JH,Lee JY.Radiological Findings of Primary Multidrug-resistant Pulmonary Tuberculosis in HIV-seronegative Patients[J].Hong Kong J Radiol,2014,17(1):4-8.
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[31]Song Q,Zhang G,Jiang H,et al.Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with MultidrugResistant Tuberculosis[J].PLoS One,2016,11(3):e0152507.
[32]Cheon H.Comparison of CT fndings of between MDRTB and XDR-TB:A propensity score matching study[J].Imaging Med,2017,9(5):125-129.
[33]Lee ES,Park CM,Goo JM,et al.Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients[J].J Comput Assist Tomogr,2010,34(7):559-563.
[34]Fishman JE,Sais GJ,Schwartz DS,et al.Radiographic fndings and patterns in multidrug-resistant tuberculosis[J].J Thorac Imaging,1998,13(2):65-71.
[35]Nunes EA,Capitini EM,Coelho E,et al.Patterns of antituberculosis drug resistance among HIV-infected patient in Maputo,Mozambique,2002-2003[J].Int J Tuberc Lung Dis,2005,9(9):494-500.
[36]Manikkam S,Archary N,Bobat R.Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting[J].SA Journal of Radiology,2016,20(1):1-6.
[37]Jeong YJ,Lee KS.Pulmonary tuberculosis:up-todate imaging and management[J].AJR Am J Roentgenol,2008,191(11):834-844.
[38]Leung AN.Pulmonary tuberculosis:the essentials[J].Radiology,1999,210(8):307-322.
[39]Kiyan E,Kilicaslan Z,Gurgan M,et al.Clinical and radiographic features of pulmonary tuberculosis in nonAIDS immunocompromised patients[J].Int J Tuberc Lung Dis,2003,7(7):764-770.
[40]Long R,Maycher B,Scalcini A,et al.The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodefciency virus type I[J].Chest,1991,99(1):123-127.
[41]Pitchenik AE,Rubinson HA.The radiographic appearance of tuberculosis in patients with the acquired immune defciency syndrome(AIDS)and pre-AIDS[J].Am Rev Respir Dis,1985,131(3):393-396.
[42]Seddon JA,Hesseling AC,Willemse M,et al.Cultureconfrmed multidrug-resistant tuberculosis in children:clinical features,treatment,and outcome[J].Clin Infect Dis,2012,54(2):157-166.
[43]Schaaf HS,Shean K,Donald PR.Culture confrmed multidrug resistant tuberculosis:diagnostic delay,clinical features,and outcome[J].Arch Dis Child,2003,88(12):1106-1111.
[44]Lamont AC,Cremin BJ,Pelteret RM.Radiological patterns of pulmonary tuberculosis in the paediatric age group[J].Pediatr Radiol,1986,16(1):2-7.
[45]Donald PR,Ball JB,Burger PJ.Bacteriologically confrmed pulmonary tuberculosis in childhood.Clinical and radiological features[J].S Afr Med J,1985,67(8):588-590.
[46]Kurbatova EV,Gammino VM,Bayona J,et al.Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis[J].Int J Tuberc Lung Dis,2012,16(6):1335-1343.
[47]Van Rie A,Warren R,Richardson M,et al.Classifcation of drugresistant tuberculosis in an epidemic area[J].Lancet,2000,356(1):22-25.
[48]Long R.Drug-resistant tuberculosis[J].CMAJ 2000,163(7):425-428.
[49]Yew WW,Chau CH.Drug-resistant tuberculosis in the1990s[J].Eur Respir J,1995,8(7):1184-1192.
[50]Gomez JE,McKinney JD.M.tuberculosis persistence,latency,and drug tolerance[J].Tuberculosis(Edinb),2004,84(1):29-44.
[51]Connolly LE,Edelstein PH,Ramakrishnan L.Why is longterm therapy required to cure tuberculosis?[J].PLoSMed,2007,4(3):e120.
[52]Blanchard JS.Molecular mechanisms of drug resistance in Mycobacterium tuberculosis[J].Annu Rev Biochem,1996,65(3):215-239.
[53]David HL.Probability of distribution of drug-resistant mutants in unselected populations of Mycobacterium tuberculosis[J].Appl Microbiol,1970,20(5):810-814.
[54]Chatterjee A,D'Souza D,Vira T,et al.Strains of Mycobacterium tuberculosis from western Maharashtra,India,exhibit a high degree of diversity and strainspecifc associations with drug resistance,cavitary disease,and treatment failure[J].J Clin Microbiol,2010,48(4):3593-3599.
[55]Metcalfe JZ,Makumbirofa S,Makamure B,et al.Drugresistant tuberculosis in high-risk groups,Zimbabwe[J].Emerg Infect Dis,2014,20(4):135-137.
[56]Perrin FM,Woodward N,Phillips PP,et al.Radiological cavitation,sputum mycobacterial load and treatment response in pulmonary tuberculosis[J].Int J Tuberc Lung Dis,2010,14(8):1596-1602.
[57]Madhi F,Fuhrman C,Monnet I,et al.Transmission of tuberculosis from adults to children in a Paris suburb[J].Pediatr Pulmonol,2002,34(3):159-163.
[58]Kritski AL,Rodrigues de Jesus LS,et al.Retreatment tuberculosis cases:factors associated with drug resistance and adverse outcomes[J].Chest,1997,111(8):1162-1167.
[59]Yew WW,Chan CK,Chau CH,et al.Outcomes of patients with multidrugresistant pulmonary tuberculosis treated with o-oxacin/levo oxacin-containing regimens[J].Chest,2000,117(3):744-751.
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[2]Chiang CY,Centis R,Migliori G B.Dru gresistanttuberculosis:past,present,future[J].Respirology,2010,15(3):413-432.
[3]Raviglione MC,Smith IM.XDR tuberculosis-implications for global public health[J].N Engl J Med,2007,356(7):656-659.
[4]Aziz MA,Wright A,Laszlo A,et al.WHO/International Union Against Tuberculosis And Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance.Epidemiology of antituberculosis drug resistance(the Global Project on Anti-tuberculosis Drug Resistance Surveillance):an updated analysis[J].Lancet,2006,368:2142-2154.
[5]World Health Organization.Global tuberculosis report.2014[EB/OL].[2015-01-21].Available online:http://www.who.int/tb/publications/global_report/en/.
[6]Orenstein EW,Basu S,Shah NS,et al.Treatment outcomes among patients with multidrug-resistant tuberculosis:systematic review and meta-analysis[J].Lancet Infect Dis,2009,9(3):153-161.
[7]Ahuja SD,Ashkin D,Avendano M,et al.Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB.Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes:an individual patient data meta-analysis of 9,153 patients[J].PLoSMed,2012,9:e1001300.
[8]World Health Organization.The use of bedaquiline in the treatment of multidrug-resistant tuberculosis:World Health Organization,2013[EB/OL].[2014-01-09].Available online:http://apps.who.int/iris/bitstream/10665/84879/1/9789241505482_eng.pdf
[9]World Health Organization.The use of delamanid in the treatment of multidrug-resistant tuberculosis:interim policy guidance[EB/OL].[2014-05-22].Available online:http://apps.who.int/iris/bitstream/10665/137334/1/WHO_HTM_TB_2014.23_eng.pdf
[10]Lam E,Nateniyom S,Whitehead S,et al.Use of drugsusceptibility testing for management of drug-resistant tuberculosis,Thailand,2004-2008[J].Emerg Infect Dis,2014,20:400-408.
[11]American Thoracic Society,Centers of Disease Control and Prevention.Diagnostic standards and classifcation of tuberculosis in adults and children[J].Am J Respir Crit Care Med,2000,161:1376-1395.
[12]Keane VP,de Klerk N,Krieng T,et al.Risk Factors for the Development of non-response to frst-line treatment for tuberculosis in southern Vietnam[J].Int J Epidemiol,1997,26(5):1115-1120.
[13]Mulu W,Mekonnen D,Yimer M,et al.Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State[J].Afr Health Sci,2015,15(2):368-377.
[14]Zhang L,Pang Y,Yu X,et al.Risk factors for pulmonary cavitation in tuberculosis patients from China[J].Emerg Microbes Infect,2016,5(10):e110.
[15]Balaji V,Daley P,Anand AA,Sudarsanam T,Michael JS,Sahni RD,Chordia P,George IA,Thomas K,Ganesh A,John KR,Mathai D.Risk factors for MDR and XDRTB in a tertiary referral hospital in India[J].PLoS One,2010,5(10):e9527.
[16]Dholakia YN,D'souza DT,Tolani MP,et al.Chest X-rays and associated clinical parameters in pulmonary tuberculosis cases from the National Tuberculosis Programme,Mumbai[J].Infect Dis Rep,2012,4(1):e10.
[17]Geng E,Kreiswirth B,Burzynski J,et al.Clinical and radiographic correlates of primary and reactivation tuberculosis:a molecular epidemiology study[J].JAMA,2005,293:2740-2745.
[18]Rozenshtein A,Hao F,Starc MT,et al.Radiographic appearance of pulmonary tuberculosis:dogma disproved[J].AJR Am J Roentgenol,2015,204(5):974-978.
[19]World Health Organization.Guidelines for the programmatic management of drug-resistant tuberculosis-2011 update.2011[EB/OL].[2011-11-18].Available online:http://www.who.int/tb/challenges/mdr/programmatic_guidelines_for_mdrtb/en/index.html.
[20]Chuchottaworn C,Thanachartwet V,Sangsayunh P,et al.Risk Factors for Multidrug-Resistant Tuberculosis among Patients with Pulmonary Tuberculosis at the Central Chest Institute of Thailand[J].PLoS One,2015,10(10):e0139986.
[21]Joshi AR,Mishra S,Sankhe AP,et al.HRCT Spectrum of Pulmonary Multidrug-Resistant Tuberculosis in HIVNegative Patients:A Study in Indian Population[J].International Journal of Science and Research,2017,6(4):596-600.
[22]Chung MJ,Lee KS,Koh WJ,et al.Drug-sensitive tuberculosis,multidrug-resistant tuberculosis,and nontuberculous mycobacterial pulmonary disease in nonAIDS adults:comparisons of thin-section CT fndings[J].Eur Radiol,2006,16(9):1934-1941.
[23]Kim HC,Goo JM,Lee HJ,et al.Multidrug-resistant tuberculosis versus drugsensitive tuberculosis in human immunodefciency virusnegative patients:computed tomography features[J].J Comput Assist Tomogr,2004,28(6):366-371.
[24]Zahirifard S,Amiri MV,Bakhshayesh Karam M,et al.The radiological spectrum of pulmonary multidrug-resistant tuberculosis in HIVnegative patients[J].Iran J Radiol2003,1(3):161-166.
[25]Kim SH,Min JH,Lee JY.Radiological Findings of Primary Multidrug-resistant Pulmonary Tuberculosis in HIV-seronegative Patients[J].Hong Kong J Radiol,2014,17(1):4-8.
[26]Yeom JA,Jeong YJ,Jeon D,et al.Imaging fndings of primary multidrug-resistant tuberculosis:a comparison with fndings of drug-sensitive tuberculosis[J].J Comput Assist Tomogr,2009,33(6):956-960.
[27]Kim W,Lee KS,Kim HS,et al.CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis[J].Acta Radiol,2016,57(2):197-204.
[28]Cha J,Lee HY,Lee KS,et al.Radiological fndings of extensively drugresistant pulmonary tuberculosis in nonAIDS adults:Comparisons with fndings of multidrugresistant and drugsensitive tuberculosis[J].Korean JRadiol 2009,10(3):207-216.
[29]Li D,He W,Chen B,et al.Primary multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in nonHIV-infected patients:Comparisons of CT fndings[J].PLoS One,2017,12(6):e0176354.
[30]Kahkouee S,Esmi E,Moghadam A,et al.Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections:a CTscan challenge[J].Braz JInfect Dis,2013,17(2):137-142.
[31]Song Q,Zhang G,Jiang H,et al.Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with MultidrugResistant Tuberculosis[J].PLoS One,2016,11(3):e0152507.
[32]Cheon H.Comparison of CT fndings of between MDRTB and XDR-TB:A propensity score matching study[J].Imaging Med,2017,9(5):125-129.
[33]Lee ES,Park CM,Goo JM,et al.Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients[J].J Comput Assist Tomogr,2010,34(7):559-563.
[34]Fishman JE,Sais GJ,Schwartz DS,et al.Radiographic fndings and patterns in multidrug-resistant tuberculosis[J].J Thorac Imaging,1998,13(2):65-71.
[35]Nunes EA,Capitini EM,Coelho E,et al.Patterns of antituberculosis drug resistance among HIV-infected patient in Maputo,Mozambique,2002-2003[J].Int J Tuberc Lung Dis,2005,9(9):494-500.
[36]Manikkam S,Archary N,Bobat R.Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting[J].SA Journal of Radiology,2016,20(1):1-6.
[37]Jeong YJ,Lee KS.Pulmonary tuberculosis:up-todate imaging and management[J].AJR Am J Roentgenol,2008,191(11):834-844.
[38]Leung AN.Pulmonary tuberculosis:the essentials[J].Radiology,1999,210(8):307-322.
[39]Kiyan E,Kilicaslan Z,Gurgan M,et al.Clinical and radiographic features of pulmonary tuberculosis in nonAIDS immunocompromised patients[J].Int J Tuberc Lung Dis,2003,7(7):764-770.
[40]Long R,Maycher B,Scalcini A,et al.The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodefciency virus type I[J].Chest,1991,99(1):123-127.
[41]Pitchenik AE,Rubinson HA.The radiographic appearance of tuberculosis in patients with the acquired immune defciency syndrome(AIDS)and pre-AIDS[J].Am Rev Respir Dis,1985,131(3):393-396.
[42]Seddon JA,Hesseling AC,Willemse M,et al.Cultureconfrmed multidrug-resistant tuberculosis in children:clinical features,treatment,and outcome[J].Clin Infect Dis,2012,54(2):157-166.
[43]Schaaf HS,Shean K,Donald PR.Culture confrmed multidrug resistant tuberculosis:diagnostic delay,clinical features,and outcome[J].Arch Dis Child,2003,88(12):1106-1111.
[44]Lamont AC,Cremin BJ,Pelteret RM.Radiological patterns of pulmonary tuberculosis in the paediatric age group[J].Pediatr Radiol,1986,16(1):2-7.
[45]Donald PR,Ball JB,Burger PJ.Bacteriologically confrmed pulmonary tuberculosis in childhood.Clinical and radiological features[J].S Afr Med J,1985,67(8):588-590.
[46]Kurbatova EV,Gammino VM,Bayona J,et al.Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis[J].Int J Tuberc Lung Dis,2012,16(6):1335-1343.
[47]Van Rie A,Warren R,Richardson M,et al.Classifcation of drugresistant tuberculosis in an epidemic area[J].Lancet,2000,356(1):22-25.
[48]Long R.Drug-resistant tuberculosis[J].CMAJ 2000,163(7):425-428.
[49]Yew WW,Chau CH.Drug-resistant tuberculosis in the1990s[J].Eur Respir J,1995,8(7):1184-1192.
[50]Gomez JE,McKinney JD.M.tuberculosis persistence,latency,and drug tolerance[J].Tuberculosis(Edinb),2004,84(1):29-44.
[51]Connolly LE,Edelstein PH,Ramakrishnan L.Why is longterm therapy required to cure tuberculosis?[J].PLoSMed,2007,4(3):e120.
[52]Blanchard JS.Molecular mechanisms of drug resistance in Mycobacterium tuberculosis[J].Annu Rev Biochem,1996,65(3):215-239.
[53]David HL.Probability of distribution of drug-resistant mutants in unselected populations of Mycobacterium tuberculosis[J].Appl Microbiol,1970,20(5):810-814.
[54]Chatterjee A,D'Souza D,Vira T,et al.Strains of Mycobacterium tuberculosis from western Maharashtra,India,exhibit a high degree of diversity and strainspecifc associations with drug resistance,cavitary disease,and treatment failure[J].J Clin Microbiol,2010,48(4):3593-3599.
[55]Metcalfe JZ,Makumbirofa S,Makamure B,et al.Drugresistant tuberculosis in high-risk groups,Zimbabwe[J].Emerg Infect Dis,2014,20(4):135-137.
[56]Perrin FM,Woodward N,Phillips PP,et al.Radiological cavitation,sputum mycobacterial load and treatment response in pulmonary tuberculosis[J].Int J Tuberc Lung Dis,2010,14(8):1596-1602.
[57]Madhi F,Fuhrman C,Monnet I,et al.Transmission of tuberculosis from adults to children in a Paris suburb[J].Pediatr Pulmonol,2002,34(3):159-163.
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