单纯性支气管结核58例临床分析

目的 :探索单纯性支气管结核的临床特征及早期确诊手段。方法 :分析 5 8例经纤维支气管镜确诊的单纯性支气管结核患者的临床表现、胸部X线、纤维支气管镜检查结果、实验室检查以及确诊前病程。结果 :5 8例中主要症状包括 :咳嗽 5 4例 ,发热 2 2例 ,咯血 14例 ,气促 8例 ,消瘦 7例 ,胸痛 5例 ,喘鸣 2例。 36例胸部X线表现未见异常。纤支镜检查示 :充血水肿型占 4 8.2 8% ,溃疡肉芽肿型占 10 .34% ,增殖型占 2 9.31% ,瘢痕狭窄型占 12 .0 7%。 5 8例FB术前行痰涂片找抗酸杆菌检查有16例阳性 (2 7.5 9% ) ,痰培养结核菌有 19例阳性 (32 .76 % ) ,5 8例经FB刷片行抗酸杆菌检查 ,有 2 6例阳性 (44.83% ) ,32例行活组织检查证实为结核有 11例 (34.38% ) ,确诊前误诊为其它疾病有 39例 ,误诊率为 6 7.2 4 %。结论 :单纯性支气管结核缺乏特异性临床表现 ,胸部X线表现正常不能排除支气管结核 ,确诊主要依靠纤支镜及痰结核菌检查。对不明原因低热和呼吸道症状经积极治疗无效者 ,应怀疑支气管结核及早行支纤镜检查。行镜下常规刷检找抗酸杆菌及取活体组织病理活检对单纯性支气管结核的诊断有非常重要意义。

Clinical analysis of 58 cases about simply bronchial tuberculosis

Objective:To explore the clinical features and early definite diagnosis of simply bronchial tuberculosis. Methods: Clinical symptoms, chest X-ray manifestations, fiberoptic bronchoscopic findings, laboratory examination and diease before being diagnosed of 58cases about simply bronchial tuberculosis diagnosed definitely byfiberoptic bronchoscopy were analyzed. Results: Main symptoms were as follows: cough in 54 cases, fever in 22 cases, haemoptysis in 14 cases,dyspnea in 8 cases, weight loss in 7 cases, chest pain in 5 cases, wheezing in 2 cases. 36 cases in chest X-ray were normal. Bronchoscopic results showed exudative lesions in 48.28% of the cases, ulcerative lesions in 10.34%, granulomatous lesions in 29.31%, cicatricial lesions in 12.07%. Positive results were found in 16 out of 58 (27.59%)by sputumacid-fast staining, 19 out of 58(32.76%) by sputum training tuberculosis bacterium before fiberoptic bronchoscopy, 26 out of 58(44.83%) by bronchoscopic brushing smears, and 11 out of 32(34.38%) by bronchialbiopsies. 39 cases were made mistakes before diagnosing, The rate of the wrong diagnosis is 67.24%. Conclusions: The clinical features of simply bronchial tuberculosis are non-specific, and bronchial tuberculosis can not be excluded only by normal chest X-ray findings, bronchoscopy and sputum tuberculosis bacterium plays imporant role in definited iagnosis of the disease. When patients with slight fever of unknown origin or respiratory symptoms do not respond to general treatment,bronchial tuberculosis should be suspected and early fibereoptic bronchoscopy be performed. Fiberoptic bronchoscopic brushing examination for acid-fast bacillus and bronchial biopsy are beneficial to definite diagnosis of simply bronchial tuberculosis.