肺部阴性的结核性变态反应综合征87例

目的探讨肺部阴性的结核性变态反应综合征的病因、发病机制、临床表现、诊断、误诊情况、治疗及预后。方法汇总分析在我院住院期间87例诊断为结核性变态反应综合征且无肺结核病灶的患者的临床资料。结果 47.13%的患者有不同程度发热,44.83%的患者出现多发性关节炎,59.77%的患者有皮肤损害,4.60%的患者出现心肌受累,73.56%的患者血沉增快,12.64%的患者出现抗"O"升高,结核菌素皮试强阳性反应90.8%,血清抗结核抗体检查71.26%阳性;临床误诊率81.61%;规则抗结核治疗率100%。结论肺部阴性的结核性变态反应综合征临床误诊率较高,结核杆菌感染所致变态反应是该综合征的始动因素,临床上以发热、皮肤结节性红斑及游走性的关节疼痛等为主要表现,血清抗结核抗体检查及结核菌素皮试有较高的诊断价值。

Analysis of 87 cases of tuberculosis allergic syndrome with negative pulmonary radiography

Objective To explore etiology,pathogenesis,clinical manifestations,diagnosis,misdiagnosis,treatment and prognosis of patients in tuberculosis allergic syndrome with negative pulmonary radiography.Methods The clinical data of 87 patients of tuberculosis allergic syndrome without tuberculosis lesions in radiography in our hospital from 2005 to 2010 were analyzed.Results There were 47.13% of the cases with different degree of fever,44.83% of the cases with polyarthritis,59.77% with skin lesions,4.60% with cardiac injury,73.56% with elevated ESR and 12.64% with increased anti-"O".The strongly positive rate of tuberculin skin test was 90.8% and 71.26% patients existed positive for TB in serum antibody test;the clinical misdiagnosis rate was 81.61% and the regular anti-TB treatment rate was 100%.Conclusion There is highly misdiagnosis rate in patients of tuberculosis allergic syndrome with negative pulmonary radiography;the initial factor of the syndrome is tubercle bacillus infection-induced allergy reaction.Fever,skin erythema nodosum and migratory joint pain are the main clinical manifestations.Serum anti-TB antibody test and tuberculin skin test are high value in diagnosis.