30例老年人肺结核误诊原因分析

目的提高对老年人非典型肺结核的认识。方法回顾性分析30例老年人肺结核误诊病例。结果30例患者临床症状和体征均不典型，胸部X线均表现为渗出性病变，痰查抗酸杆菌的阳性率低，尤其伴有其他呼吸系统疾病者。应用聚合酶链反应（PCR）技术检测支气管肺泡灌洗液（BALF）中的结核分支杆菌DNA，有助于早期确诊。结论对老年人肺部渗出性炎症经普通抗菌药物治疗无效者，应反复查痰找抗酸杆菌或应用PCR检测BALF中结核分支杆菌DNA，以期早期发现不典型肺结核，减少误诊。

AN ANALYSIS OF THE MISDIAGNOSES OF 30 CASES OF PULMONARY TUBERCULOSIS

Objective To obtain better understanding of atypical senile pulmonary tuberculosis. Methods The misdiagnoses of 30 cases of senile pulmonary tuberculosis werestudied retrospectively. Results All these cases showed no typical clinical symptoms andphysical signs. The chest x-ray examinations revealed exudative lesion and the positiverates of acid-fast bacillus in the sputum examination of these cases,especially of thosewith other respiratory diseases were low. DNA examination of the Mycobacterium in thebroncho-areloar lavage fluid (BALF) by means of polymerase chain reaction(PCR) cancontribute to early diagnosis. Conclusion Commonly-used antibiotics have been proved tobe ineffective to exudative inflammation of the aged. Repeated examinations of the acidfast bacillus in sputum or the use of PCR to detect the DNA in Mycobacterium of theBALF can help to diagnose the atypical pulmonary tuberculosis with less misdiagnoses.