有肺结核病史患者咯血的病因及临床分析

目的分析既往有肺结核病史患者咯血的病因及临床特点，为该类患者的诊治提供参考。方法回顾性分析广州市胸科医院2018年1~12月既往有肺结核病史、以咯血为主诉的182例住院患者的相关临床资料，其中男性145例，女性37例，年龄55.13±13.73岁。分析其影像学改变、支气管镜检查、病原学等结果，总结病因及临床特点。结果既往患肺结核治愈后至本次咯血发生的时间为10.13±8.29年。咯血的主要病因是肺结核后空洞继发曲菌球(23.63%)，其次是支气管扩张和肺结核复发(23.08%)、肺炎(19.23%)及NTM肺病(8.79%)，少数是肺部肿瘤(1.65%)、支气管异物(0.55%)。结论既往有肺结核病史的患者咯血绝大部分与肺的结构破坏有关，肺结核复发只是其中的病因之一，不能单凭既往有过肺结核病史和影像学改变，就诊断为肺结核复发，容易造成误诊、漏诊及误治。建议综合临床资料全面进行分析，从常见病因入手，尽量利用现有的医疗技术寻找确诊证据，同时应警惕一些少见或罕见病因。 

Etiology and clinical analysis of hemoptysis in patients with previous pulmonary tuberculosis history

ObjectiveSummarize and analyze the etiology and clinical characteristics of hemoptysis of patients with previous history of pulmonary tuberculosis to provide reference for the diagnosis and treatment of them.MethodsThe clinical data of 182 inpatients with a history of pulmonary tuberculosis and hemoptysis were retrospectively analyzed in Guangzhou Chest Hospital from January to December 2018, including imaging changes, bronchoscopy, etiology and other results. And the etiology and clinical characteristics were summarized. A total of 182 patients were included, 145 males and 37 females, with an average age at 55.13±13.73 years old.ResultsThe average time from cure of tuberculosis to hemoptysis was 10.13±8.29 years. The main causes of hemoptysis were pulmonary tuberculosis posterior cavity secondary aspergilloma (23.63%), followed by bronchiectasis and pulmonary tuberculosis recurrence (23.08%), pneumonia (19.23%) and NTM lung disease (8.79%). A few of them were lung tumor (1.65%) and bronchial foreign body (0.55%).ConclusionMost of hemoptysis in patients with a history of pulmonary tuberculosis is related to the structural damage of the lung. The recurrence of pulmonary tuberculosis is only one of the causes. The diagnosis of pulmonary tuberculosis recurrence can not just base on the past history of pulmonary tuberculosis and imaging changes. It is easy to cause misdiagnosis, missed diagnosis and mistreatment. It is suggested that comprehensive analysis of clinical data should be applied, starting from common causes, the existing medical technology should be used to find the evidence of diagnosis, and at the same time, some rare causes should be watched out for.