类风湿关节炎合并结核分枝杆菌感染患者的临床特征及胸部HRCT特征

doi:10.3969/j.issn.1671-7171.2025.08.007

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摘要【目的】分析类风湿性关节炎(RA)合并结核分枝杆菌感染患者的临床特征及胸部高分辨CT(HRCT)特征。【方法】回顾性分析2023年8月至2024年8月在长沙市中心医院诊治的68例RA合并结核分枝杆菌感染患者的临床资料,分析RA合并结核分枝杆菌感染患者的临床特征及HRCT特征。【结果】68例RA合并结核分枝杆菌感染患者的主要临床表现为咳嗽(41.18%)、关节痛(38.24%)、发热(27.94%)、体重下降及乏力(8.82%);其中活动性结核病44例(64.71%),结核分枝杆菌潜伏感染24例(35.29%)。RA合并结核分枝杆菌感染患者感染部位以肺部(肺结核)为主,占83.82%(57/68);肺外结核以关节结核为主(5.88%,4/68);其余7例为未发现感染病灶的结核分枝杆菌感染患者。57例肺部受累患者HRCT显示:6例患者病灶位于肺结核典型好发部位(即上叶尖后段或下叶背段),31例病灶在双肺散在分布,9例病灶位于双肺上叶,4例病灶位于双肺中上叶,2例病灶位于双肺下叶,2例病灶位于右肺上下叶,1例病灶位于右肺三叶,2例病灶位于左肺上下叶。57例肺部受累患者胸部HRCT特征多样化,仅有4例患者表现出单一的HRCT特征,而大多数患者呈现多种HRCT特征,同时具有斑片影、纤维条索影和结节影特征的患者占比较高。【结论】RA合并结核分枝杆菌感染患者临床表现多样,感染部位以肺部为主。此外,肺部受累患者在胸部HRCT上表现出多样化的特征,容易误诊、漏诊。

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关键词 ：关节炎,类风湿, 结核分枝杆菌, 体层摄影术,螺旋计算机

Abstract：【Objective】To analyze the clinical and chest high-resolution computed tomography (HRCT) features of rheumatoid arthritis (RA) patients complicated with Mycobacterium tuberculosis infection.【Methods】The clinical data of 68 RA patients complicated with Mycobacterium tuberculosis infection who were diagnosed and treated in Changsha Central Hospital from August 2023 to August 2024 were retrospectively analyzed, and their clinical and chest HRCT features were analyzed. 【Results】The main clinical manifestations of the 68 RA patients complicated with Mycobacterium tuberculosis infection were cough (41.18%), joint pain (38.24%), fever (27.94%), weight loss and fatigue (8.82%). Among them, 44 cases (64.71%) had active tuberculosis, and 24 cases (35.29%) had latent Mycobacterium tuberculosis infection. In RA patients complicated with Mycobacterium tuberculosis infection, the infection was mainly in the lungs (pulmonary tuberculosis), accounting for 83.82% (57/68); extrapulmonary tuberculosis was mainly joint tuberculosis (5.88%, 4/68); the remaining 7 cases were Mycobacterium tuberculosis-infected patients without detectable infection foci. The HRCT of 57 patients with lung involvement showed that the lesions of 6 patients were located in the typical predilection sites of pulmonary tuberculosis (i.e., the apical-posterior segment of the upper lobe or the dorsal segment of the lower lobe), the lesions of 31 patients were scattered in both lungs, the lesions of 9 patients were located in the upper lobes of both lungs, the lesions of 4 patients were located in the middle-upper lobes of both lungs, the lesions of 2 patients were located in the lower lobes of both lungs, the lesions of 2 patients were located in the upper and lower lobes of the right lung, the lesions of 1 patient were located in the three lobes of the right lung, and the lesions of 2 patients were located in the upper and lower lobes of the left lung. The chest HRCT features of the 57 patients with lung involvement were diverse. Only 4 patients showed a single HRCT feature, while most patients presented multiple HRCT features. Among them, the proportion of patients with patchy shadows, fibro-cord shadows and nodular shadows was relatively high. 【Conclusion】RA patients complicated with Mycobacterium tuberculosis infection have diverse clinical manifestations, and the infection site is mainly in the lungs. In addition, patients with lung involvement show diverse features on chest HRCT, which are prone to misdiagnosis and missed diagnosis.

Key words： Arthritis, Rheumatoid Mycobacterium tuberculosis Tomography, Spiral Computed

收稿日期: 2025-05-15

中图分类号:

R593.22

引用本文:

鲜瑶瑶, 欧降红, 黄巍, 吴永胜, 杨晓云. 类风湿关节炎合并结核分枝杆菌感染患者的临床特征及胸部HRCT特征[J]. 医学临床研究, 2025, 42(8): 1318-1320.
XIAN Yaoyao, OU Jianghong, HUANG Wei, et al. Clinical and Chest HRCT Features of Rheumatoid Arthritis Patients Complicated with Mycobacterium Tuberculosis Infection. JOURNAL OF CLINICAL RESEARCH, 2025, 42(8): 1318-1320.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.08.007 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I8/1318

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