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目的探讨胸部CT上胸膜下带状分布磨玻璃影(GGO)对百草枯中毒性肺炎的诊断及鉴别诊断价值。方法回顾性分析2013年3月至2015年3月期间住院的百草枯中毒性肺炎、间质性肺炎及肺泡蛋白沉积症(PAP)患者胸部CT及临床资料,分析比较胸膜下带状分布GGO及其他影像学特征对百草枯中毒性肺炎的诊断及鉴别价值。结果共14例百草枯中毒患者入选,其中6例胸部CT有GGO,比例为42.9%。共698例间质性肺炎患者入选,其中胸部CT上表现有GGO者392例,占56.2%。共38例PAP患者入选,胸部CT有GGO者比例高达100.0%。百草枯中毒性肺炎胸部CT上表现为GGO的患者中具有胸膜下带状GGO特征者占83.3%。而在PAP及间质性肺炎胸部CT上具有GGO的患者中具有胸膜下带状GGO特征者分别占18.4%和5.6%,均显著低于百草枯中毒性肺炎(P<0.05)。PAP组患者胸膜下带状GGO均并存铺路石征,而在间质性肺炎及百草枯中毒性肺炎组中均未发现并存铺路石征。GGO伴铺路石征在PAP组高达94.7%,而间质性肺炎组中仅为0.5%,百草枯中毒性肺炎组中未发现。GGO伴蜂窝样改变及GGO伴胸膜下线在间质性肺炎组中分别占22.7%和11.2%,而在PAP组及百草枯中毒性肺炎组中均未见有并存蜂窝样改变和胸膜下线。结论胸部CT上胸膜下带状分布GGO最常见于百草枯中毒性肺炎,较少见于PAP及间质性肺炎患者。结合其CT上有无合并铺路石征及胸膜下线等其他影像学特征对百草枯中毒性肺炎具有一定的鉴别诊断意义。
Objective To investigate the diagnosis and differential diagnosis of paraquat poisoning pneumonia on chest CT with GGO. Methods The chest CT and clinical data of paraquat poisoning pneumonia, interstitial pneumonia and pulmonary alveolar proteinosis (PAP) hospitalized from March 2013 to March 2015 were analyzed retrospectively. The distribution of GGO in subpleural Diagnostic Value of Other Imaging Features on Paraquat Toxic Pneumonia. Results A total of 14 cases of paraquat poisoning were enrolled. Among them, 6 cases had chest CT with GGO (42.9%). A total of 698 cases of interstitial pneumonia were selected, including 392 cases of GGO in chest CT, accounting for 56.2%. A total of 38 cases of PAP patients were selected, the proportion of chest CT GGO up to 100.0%. Paraquat poisoning pneumonia Chest CT showed GGO patients with subpleural GGO features 83.3%. However, patients with GGO on PAP and interstitial pneumothorax CT had 18.4% and 5.6% of GGO subtype, respectively, which were significantly lower than those of paraquat poisoning pneumonia (P <0.05). PAP group of patients with subpleural GGO are coexisting paving stone syndrome, and in the interstitial pneumonia and paraquat toxic pneumonia were not found coexisting paving stone syndrome. GGO with paving stone sign in the PAP group up to 94.7%, while interstitial pneumonia group was only 0.5%, paraquat poisoning pneumonia group was not found. GGO with honeycombing-like changes and GGO with subpleural line in the interstitial pneumonia group accounted for 22.7% and 11.2%, respectively, while in PAP group and paraquat toxic pneumonia group, no coexistence of honeycomb-like changes and subpleural line . Conclusions The subpleural zonal distribution of GGO on chest CT is most common in paraquat poisoning pneumonia and less in patients with PAP and interstitial pneumonia. Combined with its CT on the presence of paving stones and other imaging characteristics of subpleural line of paraquat poisoning pneumonia has a certain differential diagnosis.