Clinical analysis of pulmonary tuberculosis in association with corticosteroid therapy

In the last five years, five patients (three males and two females) among a total of 162 patients (3.1%) ranging from 63 to 79 years old developed pulmonary tuberculosis during the long-term corticosteroid therapy. The underlying diseases of these cases were pulmonary fibrosis in two, polyarteritis nodosa in one, RPGN + pulmonary bleeding in one, and mycosis fungoides in one. The total corticosteroid dose used until the clinical diagnosis of pulmonary tuberculosis was 1.16 g to 5.60 g and the term of administration was two to nine and a half months. Other immunosuppressive drugs were administered to two patients. Though chemoprophylaxis with INH was done in two patients for three months, it was impossible to prevent the development of pulmonary tuberculosis. Since almost all patients except one complained no symptoms at the onset, the follow-up with chest roentgenograms seemed to be most important during corticosteroid therapy, and in fact, four patients were detected by the follow-up. Antituberculous chemotherapy was effective in four patients but was not carried out for one patient due to the delay in the diagnosis. Careful clinical observation, such as by chest roentgenograms, seems to be appropriate for the early diagnosis and treatment of pulmonary tuberculosis in patients on corticosteroid therapy.     

Clinical analysis of patients with sequelae of pulmonary tuberculosis undergoing home oxygen therapy

PURPOSE: To clarify the clinical characteristics of patients with sequelae of pulmonary tuberculosis undergoing home oxygen therapy. OBJECTS AND METHODS: We conducted a cross-sectional survey of those with newly-introduced home oxygen therapy for the sequelae of pulmonary tuberculosis from 1998 through 2001, using national hospital network of respiratory diseases. RESULTS: The study subjects were 402 in total (271 men and 131 women), who started the home oxygen therapy at the age ranging between 33 and 100 years (72.2 +/- 8.1 years, mean +/- S.D.). They suffered from pulmonary tuberculosis at the mean age of 37.7 +/- 19.4 years, and the interval leading to oxygen therapy averaged 33.1 +/- 19.1 years. Sixty-eight percent of these patients demonstrated body mass index (BMI) less than 20. Pulmonary function studies revealed the markedly-decreased vital capacity (46.2 +/- 15.0%) as well as reduced FEV1/FVC (68.5 +/- 18.8%). Arterial blood gases measured when home oxygen therapy was introduced showed hypoxemia (Pa(O2), 60.4 +/- 10.7 Torr) with hypercapnea (Pa(CO2), 50.5 +/- 9.4 Torr). The average flow rate of oxygen was 0.94 +/- 0.64 L/min at rest and 1.51 +/- 0.70 L/min on exertion. The patients were divided into two groups; those with surgical intervention including thoracoplasty or lung resection (126 cases, group 1) and those without surgery (148 cases, group 2). The mean age of the patients in the group 1 when home oxygen therapy was started was 72.3 +/- 6.4 years and 71.6 +/- 9.1 years in the group 2, respectively. Subjects in group 1 were more likely suffered from TB in younger age than those in group 2 (28.2 +/- 9.7 vs. 45.4 +/- 21.5 years, p < 0.01), and had the longer duration to initiate domiciliary oxygen therapy (43.0 +/- 10.9 vs. 25.3 +/- 20.3years, p<0.01). The former was also more likely to have lower % VC (p < 0.01), more elevated Pa(CO2) (p<0.05), and lower inspired flow rate of oxygen (p<0.01). There was no significant difference between the two groups with respect to BMI, FEV1/FVC, or CONCLUSION: Our investigation demonstrated that patients with sequelae of pulmonary tuberculosis under oxygen therapy revealed the different clinical course and characteristics regarding the presence or absence of previous surgical intervention.     

儿童肺结核42例临床分析

目的提高对儿童肺结核的认识和诊断水平。方法回归性分析2005年1月-2012年1月收治的42例肺结核患儿的临床和影像学资料。结果42例患儿中男性28例(66.7%),女性14例(33.3%);年龄5岁以下31例(73.8%),5岁~12岁11例(26.2%);PPD为(++)及以上者为71.4%,阴性为9.5%。症状以发热(57.1%)和咳嗽(76.2%)为主要表现,有结核中毒症状如乏力盗汗和消瘦等占66.7%,浸润性肺结核占23.8%,合并肺外结核占38.1%,大部分病例(71.4%)在病程中未得到及时诊断,误诊时间最长达8个月。结论儿童肺结核病的临床诊断主要是依据结核中毒症状、结核接触史、是否有卡介苗疤痕、PPD试验结果、影像学检查等综合分析。     

肺结核合并肺念珠菌病12例临床分析

目的 探讨减少肺结核合并肺念珠菌病的发生和误诊?方法 以肺结核病情好转或稳定中, 出现新的症状, X 线片显示新病灶或原病灶扩大, 痰真菌培养连续三次生长同种真菌且抗真菌治疗后病情改善, 痰真菌培养无原真菌生长为标准?12 例病人被确诊合并肺念珠菌病并作回顾性分析?结果 本组病人肺结核病灶范围较广泛, 空洞多, 痰菌阳性率高, 多有高热?血白细胞和中性粒细胞数较高, 及广谱抗生素和糖皮质激素使用史, 多误诊?结论 本病易误诊, 临床应予重视, 规则使用广谱抗生素和激素可减少它的发生?     

Hypertrophic osteoarthropathy in association with pulmonary tuberculosis

Three white male patients with advanced cavitary pulmonary tuberculosis presented with HOA. No other pathology to explain the osteoarthropathy was detected. The osteoarthropathy responded symptomatically to NSAI drugs and treatment of tuberculosis but resolved radiologically in only one patient.     

老年人肺结核的临床分析

目的探讨老年人肺结核的临床特征。方法分析106例60岁以上老年人肺结核的临床资料。结果60岁以上肺结核患者病灶范围广、易形成空洞、痰阳性率高、合并症多、症状不典型、易造成误诊。结论对因呼吸道症状就诊的老年人,对原有肺结核病史应加以重视,积极查痰及胸部X线检查,以便及早发现,及早治疗。     

67例婴幼儿肺结核临床诊断分析

目的分析婴幼儿肺结核的临床诊断特点。方法对67例婴幼儿肺结核的卡介苗接种情况、结核接触史、临床表现、实验室检查、胸部影像学特点、PPD试验结果进行回顾性分析。结果67例患儿中未接种卡介苗20例(29.9%);有结核接触史31例(46.3%),外来人口26例(38.8%);发热51例(76.1%),有呼吸道症状者59例(88.1%),有神经系统症状者15例(22.4%);PPD(-)14例(20.9%),CRP升高50例,ESR升高45例(67.1%)血常规检查示白细胞升高45例(67.2%),白细胞分类中性粒为主者49例(73.1%);67例行X线胸片检查,其中16例(23.9%)仅见两肺纹理增多增粗、未见实质性病灶,CT检查58例,其中2例未见明显异常。最后诊断为原发型肺结核40例,占59.7%,血行播散性肺结核14例,占20.9%;继发性肺结核5例,占7.5%;结核性胸膜炎8例,占11.9%。结论婴幼儿肺结核有一定的临床特点,临床应注意早期诊断;同时应该加强外来流动人口的结核病防治工作,普及外来人口儿童的卡介苗接种率。     

老年性肺结核患者60例临床分析

目的 了解老年肺结核的临床特点,为诊断和治疗老年肺结核提供参考.方法 对我院诊断明确的60例老年肺结核患者,从临床症状、体征、合并症、实验室检查X线胸片、临床诊断类型等方面进行观察分析.结果 老年肺结核患者临床症状以肺部症状和全身症状为主;合并症多,以肺部疾患、心脑血管病和糖尿病为主;实验室检查阳性率较低;胸部X线病灶肺部广泛、类型多样,不易判别;诊断类型多样,以浸润型为主;对治疗反应性较差.结论 结合临床实际,提高对老年肺结核患者的临床特点和复杂性的认识,诊断中要综合应用各种诊断方法,提高诊断准确性,治疗上要全面考虑,综合治疗,合理用药.     

93 例老年结核病的临床分析简

目的 探讨老年结核病的临床特点及防治策略.方法对93例确诊老年结核病患者与同期住院的中青年患者进行分析.结果 老年结核病患者中肺结核或肺结核合并胸膜炎发病率较高;其中开放性肺结核16例（17.2%）,初治菌阳14例（15.1%）,复治菌阳2例（2.1%）;肺结核合并其他疾病患者58例（62.4%）;免疫功能低下19例（20.4%）.结论 老年结核病早期诊断及免疫增强剂联合个体化抗结核治疗、同时积极合发症对治愈老年结核患者,控制结核病的蔓延有一定的临床意义.     

肺结核合并肺部真菌感染的临床疗效分析

目的 研究肺结核患者合并肺部真菌感染的临床治疗效果.方法 选择2012年12月至2014年12月期间入院治疗的35例肺结核合并肺部真菌感染的患者为研究对象,采用回顾性分析的方式对其临床治疗资料进行研究.采用SPSS 16.0软件进行统计学分析,治疗前后的结果分别使用x2和t检验进行差异性比较,显著性水平设定为α=0.05.结果 患者临床治疗总有效率为94.29％(33/35),真菌感染以白色念珠菌为主,占28.57％(10/35).治疗前后患者的痰真菌涂片培养阳性率分别为94.29％(33/35)、2.86(1/35),差异有统计学意义(x2=164.94,P＜0.05).治疗前后血常规及生化指标比较,白细胞计数从治疗前的(5.8±1.6)×109/L下降到治疗后的(4.7±1.5)×109/L (t=2.96,P＜0.05);血小板计数从治疗前的(228.7±68.8)×109/L下降到治疗后的(178.3±58.2)×109/L(t=3.30,P＜0.05);丙氨酸转氨酶从治疗前的(22.4±5.3)U/L下降到治疗后的(16.4±6.5) U/L(t=4.23,P＜0.05);血尿酸从治疗前的(585.3±185.6) μmol/L下降到治疗后的(456.5±183.8) μmol/L (t=2.93,P＜0.05).结论 肺结核患者容易发生侵袭性真菌感染,采用多种方式联合治疗的方法可达到明显的治疗效果.     

78例肺结核合并喉结核临床分析

目的 探讨肺结核合并喉结核的临床特征,提高肺结核合并喉结核的诊疗水平.方法 回顾性分析2016年4月至2019年8月入住我院的78例肺结核合并喉结核患者的临床资料,包括:电子支气管镜、胸部CT、活检病理、抗酸染色涂片、结核菌培养、结核菌分子检测等结果,同时了解是否合并其他部位结核、诊疗经过是否存在误诊,并对抗结核方案及...     

肺结核合并重症肺炎35例临床分析

目的　探讨肺结核合并重症肺炎的临床特征及病原菌分布和诊疗技术。方法 对1995年1月—2002年12月收治的经纤维支气管镜保护性刷检(PSB)病原学确诊的肺结核合并重症肺炎35例进行回顾性分析。结果 临床特征是高热、咳脓痰、气急、呼吸衰竭、白细胞总数升高。病原菌以嗜麦芽窄食单胞菌、厌氧菌、绿脓杆菌感染为主。治愈31例,病死4例,病死率11.4%。结论 纤支镜PSB检查能及时、准确提供肺结核合并重症肺炎的病原学诊断依据,并指导临床合理使用抗生素。第三代青霉素及头孢菌素与β内酰胺酶抑制剂的复合制剂及甲哨唑疗效显著。合理把握机械通气指征及策略,可提高救治成功率。     

耐利福平肺结核病人的治疗观察

目的探讨含二线药物治疗方案的有效性和安全性。方法采用多中心、随机分组方法,将耐药结核病监测中发现的耐药肺结核（至少耐利福平）患者154例,随机分入观察组和对照组,采取不同化疗方案治疗。观察组以二线抗结核药物为主;对照组则为国家结核病控制规划制订的复治方案,均为一线抗结核药物。以细菌学和影像学改变作为疗效评价标准。结果(1)114例完成全程治疗,40例患者退出研究,其中对照组26例,观察组14例（P>0.05）;(2) 细菌学改变：观察组痰菌转阴率为81.7%,对照组为70.0%（P>0.05）。在病变范围较小者中,观察组和对照组痰菌转阴率分别为90.3%、90.0％（P>0.05）,在病变范围较大者中,观察组和对照组痰菌转阴率分别为77.5%、52.2％（P<0.05）。(3)影像学改变：2组X线胸片病灶吸收差异无统计学意义。(4) 安全性：观察组和对照组中发生不良反应的分别有17例、8例（P>0.05）。结论对于初治的耐药肺结核患者,以及病变较广泛的耐药肺结核患者,采用含二线药物的治疗方案同样安全,但疗效可能更好。