196例肺结核患者的临床病例分析

目的 探讨肺结核患者的临床病例特点.方法 收集住院及门诊明确诊断为肺结核患者196例,其中女89例,男107例,平均年龄(46.28±15.05)岁.采集既往病史、临床症状、影像、结核菌素试验(PPD)、抗酸染色、支气管镜检查及CT引导经皮穿刺肺活检结果 ,同时采集应用喹诺酮类药物史,发病到确诊时间.结果98例患者年龄>65岁;134例患者伴有基础疾病史,包括糖尿病、慢性阻塞性肺疾病、支气管扩张、慢性心功能不全、慢性肾功能不全、结缔组织病、应用激素史;39例患者曾患肺结核;124例患者影像改变位于典型位置,72例患者影像改变位于非典型位置,其中58例患者有空洞病变,23例患者有胸腔积液;166例患者PPD试验阳性,强阳性10例,阴性20例;69例患者痰抗酸染色呈阳性;57例患者支气管镜刷片抗酸染色呈阳性;34例患者经皮肺活检病理证实;发病到确诊时间1周 ～2个月.结论 肺结核患者临床表现不典型,年龄大患者合并症多,为及时诊断肺结核,有创检查是必要的,高度怀疑肺结核患者应尽量避免应用喹诺酮类抗生素.

Clinical analysis of 196 patients with pulmonary tuberculosis

Objective To explore the clinical characteristics of tuberculosis patients. Methods One hundred and ninety-six patients with clear diagnosis of tuberculosis were collected,including 89 males and 107 females with an average age of (46. 28 ± 15. 05) years from January 2014 to December 2016 in Xuanwu Hospital Capital Medical University. The results of previous history,clinical symptoms, imaging,PPD test,acid-fast staining,bronchoscopy and CT-guided percutaneous biopsy were collected. The history of quinolone was col-lected and the time from onset to diagnosis time. Results There were 98 patients over 65 years of age,134 patients with basic disease history,including diabetes,chronic obstructive pulmonary disease,bronchiectasis,chronic heart failure,chronic renal insufficiency,con-nective tissue disease,hormone history and 39 patients withtuberculosis. 124 images were located in the typical position,72 images were located in atypical position,of which 58 cases of patients with empty lesions included 23 cases of pleural effusion. There were 166 pa-tients with PPD test positive,10 cases of strong positive. 69 cases of sputum acid-fast staining were positive,57 cases of bronchoscopy brushing acid-fast staining were positive. 34 patients were confirmed by percutaneous lung biopsy. The time from onset to diagnosis ranged from 1 week to 2 months. Conclusions The clinical manifestations of tuberculosis patients are not typical. Older patients have more complications. For the timely diagnosis of tuberculosis,invasive examination is necessary. Highly suspected tuberculosis patients should try to avoid the application of quinolone antibiotics.