抗结核化疗过程中病情恶化原因分析——附23例临床报告

目的探讨抗结核化疗过程中临床症状和/或X线恶化的原因,分析其误诊误治情况及鉴别诊断的重要性。方法回顾性分析近年收治的初治肺结核613例,其中23例在抗结核化疗过程中出现临床症状和/或X线恶化。结果导致恶化的原因以类赫氏反应居多(56.5%),其次为继发肺炎(26.1%)、初始耐药(8.7%)、并发肺癌(8.7%)。结论各种原因所致病情恶化临床表现相似,易相互混淆。鉴别诊断是诊治该现象的关键。

Study of the Causes of Deterioration During Antituberculosis Therapy

Objective To study the causes of deterioration showing in the clinical symptom and X-ray diagnosis during antituberculosis therapy, and the misdiagnosis and mistreatment of these patients. Methods 613 patients with pulmonary tuberculosis treated in our hospital in recent years were retrospectively analyzed. All of them got initial antituberculosis chemotherapy. 23 of them showed deterioration of clinical condition during chemotherapy. Results During antituberculosis chemotherapy 56.5% of the patients showed Herxheimer-like reaction;26.1% developed secondary pneumonia; 8.7% had initial drug resistance; and 8.7% had lung cancer. Conclusion The deteriorated situations were resulted from different causes and showed similar clinical manifestations, which could lead to confusion. Differential diagnosis was the key to deal with patients showing deterioration during treatment.