老年COPD长期应用糖皮质激素合并肺结核的临床特点及斯普林的辅助治疗作用

目的探讨老年慢性阻塞性肺病（COPD）长期应用糖皮质激素并发肺结核的临床特点及斯普林的辅助治疗作用。方法回顾分析9例去年COPD长期应用糖皮质激素并发肺结核的临床表现,X线和实验室及诊治情况,并与10例非COPD的老年肺结核患者对照分析。结果 9例患者临床表现主要为咳嗽、咳痰,而发热、盗汗远少于非COPD组。X线表现不典型多为双肺病变,抗酸杆菌阳性率22%,与非COPD组相近（20%）,差异无统计学意义（P〉0.05）;PPD阳性率22%远低于非COPD组（50%）,差异有统计学意义（P〈0.005）。结论老年COPD长期应用糖皮质激素并发肺结核的临床不典型,抗酸杆菌阳性率高,PPD阳性率较低。因此,尽早诊断和治疗是重要的。与抗结核药联合,提高免疫辅助治疗,应用斯普林可增进抗结核药的疗效改善患者自身细胞免疫功能。

Clinic characteristic of COPD with glucocorticoid in treatment long time with pulmonary tuberculosis in elder patients and effect of Spipulin

OBJECTIVE To study clinic characteristic of COPD with glucocorticoid in treatment long time with pulmonary tuberculosis in elderly patients,observe effect of sipulin unite anti-tuberculosis drugs.METHODS Retrospective analysis of 9 cases were performed and the clinic manifestations included x-ray,laboratory examination results,diagnosis and treatment condition,and compared with 10 cases from control group.RESULTS 9 cases have cough and expectoration,but fever and night sweat were lesses than control group;two lungs shouwed with chest x-ray dip-pulmonary lesion;the popsitive sputume smear were 22% in COPD groups and 20% incontrol groups,there was no differences（P〉0.05）;the positive PPD were 22% in COPD groups and 50% in control groups,and there was a statistical difference between two groups（P〈0.005）.CONCLUSION These Patients have multiple clinic symptoms and their x-ray results show extensive damages.These patients have high positive rate of the sputum examinations,lower PPD positive tate.It is important for an early diagnosis and treatment for these patients.The treatment combining Sipulin with antituberculosis drug can improve the effect and enhance the immunity of the patients.