肺结核合并肺曲菌病12例临床分析

目的探讨肺结核合并肺曲菌病的临床特点，诊断和鉴别诊断。方法对1990年-2008年期间12例肺结核合并肺曲菌病的临床表现、X线、CT征象和病理证实情况进行总结分析。结果本组肺组织标本病理切片见曲菌丝体寄生在肺结核空洞内7例，支气管内3例，肺组织内2例。本组有5例依据临床表现、胸部X线、CT征象等综合诊断外，其余4例误诊为结核性支气管扩张，3例误诊为肺癌。结论本组多见肺结核合并感染，长期应用抗生素、免疫药物后的患者，临床表现反复咯血，迁延不愈，痰抗酸杆菌往往阴性时，结合X线、CT征象，应注意合并曲菌感染的可能，反复痰曲菌检查或纤维支气管镜检查，有助诊断。手术病理检验可以确诊。

Clinical analysis of 12 cases of pulmonary tuberculosis complicated with aspergillomycosis

Objective To explore the clinical characteristic, diagnosis and differential diagnosis. Methods To analyze the clinical situation, X-ray, CT-sign and pathology of 12 cases of pulmonary tuberculosis （TB） complicated with aspergillomycosis from year of 1990 to 2008 in the retrespeetive study. Results Among pathological sections of 12 cases, there were 7 cases of hyphostroma parasitized in cavitates of pulmonary tuberculosis, 3 cases in endotraeheal and 2 eases in pulmonary. 5 cases were diagnosed according to the clinical situation, X-ray and CT-sign ; 4 cases were misdiagnosed as bronehieetasis of TB ; and 3 cases were misdiagnosed as lung cancer. Conclusion It is possible to be complicated with aspergillomyeosis in the condition of TB concurrent infection, repeatedly hemoptysis after use of antibiotics immuno-drug. We should diagnose the cases of pulmonary tuberculosis complicated with aspergillomycosis, according to the resuits of X-ray, CT-sign, spit check and bronchofiberseopy, etc, but only pathology could make a definite diagnosis.