19例肺曲霉菌病误诊为肺结核的原因分析

目的]了解肺曲霉菌病患者的临床特征及误诊原因。方法]对误诊为肺结核并经手术病理证实为肺曲霉菌病的19例病人的资料进行分析。结果]19例病人中，男性12例，女性7例；年龄17～55岁，平均35．8岁。病程6个月至20年。主要症状为咳嗽、咳痰16例，占84．3％；咳血17例，占89．5％；发热4例，占21．1％。胸部X线表现为团块或结节影7例，占42．1％，均为单发；形态各异的片状、条索状阴影11例，占57．9％；一侧肺损毁1例，占0．53％；有典型“新月征”表现7例，占42．1％。病变位于上叶尖后段、下叶背段及一侧肺17例，占89．5％。所有病例痰涂片培养检查均阴性，经正规抗结核及抗炎治疗（其中6例术前曾抗真菌治疗），病情变化不明显。结论]误诊原因主要是肺曲霉菌病与肺结核病的临床表现及X线表现相似，痰曲霉菌痰检培养检查阳性率低。部分病例既往有肺结核病史，如病情有变化，易认为是结核复发。因此对反复咯血、抗结核治疗效果不佳或X线胸片有“空气新月征”表现者应考虑是否是肺曲霉菌病，如果有条件者及时手术治疗。

Analysis of Misdiagnosis of 19 Pulmonary Aspergiilosis Cases as Tuberculosis

Objective] To analyse the clinical characteristic and misdiagnosis of pulmonary aspergillosis patients. Methods]An retrospective study was carried out in 19 cases that have been misdiagnosed as tuberculosis（TB）and finally diagnosed aspergillosis by operation. Results]There were 12 male patients and 7 female patients aged from 17 to 55 and average age was 35.8. The duration of illness from 6 months to 20 years. The main symptoms were cough and sputum accounting for 84.3 %, haemoptysis accounting for 89.5 % and fever accounting for 21.1% . Analysing the images, there were 7 cases with ball or node in X-ray and all were single. There were 11 cases with differently sheet and streaky shadow in X- ray, there was 1 case with one lung destroyed, there were 7 cases with＂new moon＂signs accounting for 42.1 %. The pathological changes usually locates in the upper and under lobar and single lung, which are the frequently place that TB happened（accounting for 89.5% ）. The sputum test of all cases were negative, by giving normally therapy of anti-TB and antiinflammation, and the state of illness of all cases were unconspicuous after therapy,including 6 cases that treated with antigungal before operation, Conclusion]The misdiagnosis was that the clinical and X-ray exhibitions of TB were similar to that of aspergillosis. The positive of sputum test for aspergillosi was low. With the effect of old TB history,if the state of illness were changed,it easily mistook as TB recurred. If the patient whose chest X-ray has＂new noon＂signs has repeated cough and sputum and the effect of antituberculosis is not good, we should think of aspergillosi and operated in time on these patients.