成人支原体肺炎58例误诊为肺结核临床探讨

目的探讨成人支原体肺炎（mycoplasma pneumoniae pneumonia，MPP）与肺结核的临床鉴别要点，避免误诊误治。方法对我院收治的58例误诊为肺结核的支原体肺炎患者的临床资料进行回顾性分析。结果2009--2010年经血清学证实的MPP124例，其中58例误诊为肺结核，误诊率46．77％。本组17～50岁47例，有类结核感染中毒症状31例。胸部CT均表现为斑片状影和网织条索影的混合病灶，病变累及双肺21例，双叶29例，上叶尖后段25例，下叶14例，合并胸腔积液4例。结核菌素纯蛋白衍生物（PPD）试验阴性41例，阳性17例。病程第1周行血MP-IgM检测21例，阳性6例；第2周及以后检测52例，均阳性。本院首诊误诊10例，外院误诊48例；误诊时间在2周内者占总数的63．79％。确诊后均治愈。结论成人MPP临床特点与肺结核相似，尤其病变累及肺结核好发部位时，易误诊为肺结核，成人及青少年PPD试验阴性时，临床诊断肺结核应慎重。

Analysis of Mycoplasma Pneumoniae Pneumonia Misdiagnosed as Pulmonary Tuberculosis in 58 Adult Patients

Objective To distinguish between mycoplasma pneumoniae pneumonia and pulmonary tuberculosis in adults so as to avoid misdiagnosis.Methods Retrospective analysis of clinical data of 58 patients with mycoplasma pneumonia misdiagnosed as having smear negative pulmonary tuberculosis was conducted.Results Between 2009 and 2010,124 patients were diagnosed as having MPP by serological testing,among whom,58 were misdiagnosed as having pulmonary tuberculosis,and the misdiagnosis rate was 46.77%.47 patients aged between 18-50,and 31 patients with TB symptoms were involved.All the patients showed mixed lesions with patching and reticulated cord in chest computer tomography(CT).21 patients were invaded in both lungs,29 patients were invaded in double lobes,25 patients were invaded in lobus superior apicoposterior segment,14 patients were invaded in inferior lobe and 4 patients were combined with pleural effusion.By purified protein derivative(PPD) of tuberculin test,41 cases were negative while 17 patients were positive in results.By serological tests,6 cases of 21 were MP-IgM detected positively in the first week;37 cases of 52 were positive in the second week,and 15 cases were positive after the third week.10 patients were misdiagnosed in our hospital and 48 patients were misdiagnosed in other hospitals.The rate of misdiagnosed time for 2 weeks was 63.79%.All the patients were cured after final diagnosis.Conclusion Mycoplasma pneumonia shows similar clinical characteristicswith pulmonary tuberculosis in adults.Mycoplasma pneumonia is easily misdiagnosed as pulmonary tuberculosis especially when it shows similar features on chest imaging.Physicians should pay more attention when the result is negative by PPD test in both adults and teenagers in order to avoid misdiagnosis.