| 文小检,凌杰,尹曲华.非HIV感染多部位骨骼受累播散性非结核分枝杆菌病临床及影像学表现[J].中国医学影像技术,2025,41(10):1715~1719 |
| 非HIV感染多部位骨骼受累播散性非结核分枝杆菌病临床及影像学表现 |
| Clinical and imaging manifestations of disseminated nontuberculous mycobacteria disease involved multiple skeletons of non-HIV-infected patients |
| 投稿时间：2024-12-10 修订日期：2025-06-11 |
| DOI：10.13929/j.issn.1003-3289.2025.10.024 |
| 中文关键词: 非结核分枝杆菌 结核,骨关节 体层摄影术,X线计算机 磁共振成像 |
| 英文关键词:nontuberculous mycobacteria tuberculosis, osteoarticular tomography, X-ray computed magnetic resonance imaging |
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| 中文摘要: |
| 目的 观察非HIV感染而累及多部位骨骼的播散性非结核分枝杆菌(NTM)病的临床及影像学表现。方法 回顾性纳入11例非HIV感染累及多部位骨骼播散性NTM病(NTM组)及30例累及多部位骨骼的骨结核(TB)(TB组)患者,对比观察其临床及影像学表现。结果 NTM组9例(9/11,81.82%)存在全身性基础病变,包括慢性贫血5例、风湿免疫病4例及痛风1例。NTM组病程长于、发热及软组织包块发生率低于、血红蛋白低于而红细胞沉降率快于TB组(P均＜0.05)。NTM组肺部条片/索条影、脊柱"跳跃式"表现、受累骨骼呈斑片状/结节状高密度影发生率均高于,而肺部血行/支气管播散灶、肺部多形性病变、受累骨骼骨质破坏伴死骨/周围软组织脓肿发生率均低于TB组(P均＜0.05)。NTM组病变最常累及胸椎、肩关节及骨盆,TB组以胸、腰椎受累最常见;组间骨骼受累部位差异有统计学意义(P=0.035)。经药物治疗后,NTM组9例(9/11,81.82%)病情减轻、骨质破坏及周围软组织肿胀好转,骨质硬化较前明显。结论 非HIV感染累及多部位骨骼播散性NTM病易继发于慢性贫血及风湿免疫病,具有病程长、肺部表现轻等特点;影像学常见胸椎、肩关节、骨盆多发骨质破坏,呈"跳跃式"分布,伴/不伴骨质硬化及邻近软组织肿胀。 |
| 英文摘要: |
| Objective To observe the clinical and imaging manifestations of disseminated nontuberculosis mycobacteria (NTM) disease involved multiple skeletons of non-HIV-infected patients. Methods Totally 11 cases of non-HIV-infected patients with disseminated NTM involved multiple skeletons (NTM group) and 30 patients of bone tuberculosis with multisite skeletal involvement (TB group) were retrospectively analyzed. Clinical and imaging manifestations were analyzed and compared between groups. Results Nine cases (9/11, 81.82%) in NTM group were found with systemic underlying disease, including 5 cases of chronic anemia, 4 cases of rheumatic immune diseases and 1 case of gout. NTM group had longer disease duration, lower incidence of fever and soft tissue masses, lower hemoglobin and higher erythrocyte sedimentation rate than TB group (all P＜0.05). NTM group exhibited higher incidences of pulmonary patchy/linear shadows, "skip-like" manifestations in spine and patchy/nodular high-density shadows in the affected bones, but lower incidences of pulmonary hematogenous/bronchial dissemination foci, polymorphic lung lesions and bone destruction with sequestrum/surrounding soft tissue abscesses than TB group (all P＜0.05). The thoracic vertebrae, shoulder joints and pelvis were most commonly affected in NTM group, while the thoracic and lumbar vertebrae were most commonly affected in TB group. Significant difference of skeletal involvement site was found between groups (P=0.035). After drug treatment, the conditions of 9 cases (9/11, 81.82%) in NTM group improved, with better outcomes in bone destruction and surrounding soft tissue swelling, and bone hardening was more obvious than before. Conclusion Disseminated NTM disease involved multiple skeletons in non-HIV-infected patients was prone to secondarily develop in those with chronic anemia and rheumatologic immune diseases, characterized by prolonged disease duration and mild pulmonary manifestations, often revealed multiple skeletons destruction in thoracic spine, shoulder joints and pelvis, distributed in a "skip-like" pattern, with or without bone sclerosis and adjacent soft tissue swelling. |
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