成人急性栗粒性肺结核临床研究

目的 分析成人急性粟粒性肺结核(CMPT)临床特点。方法 我科1995-2001年住院78例CMPT临床特点作回顾性分析。结果 1．CMPT以青壮年居多，近年老年患者渐有增多趋势。2．58．97％患者在出现临床症状后30天内确诊，少数病人至6个月时确诊。3．全身症状明显(发热88．6％)，呼吸道症状以咳嗽、咳痰、气促居多。4．末梢血白细胞正常或增高居多，少数病人可出现白细胞减少，42．25％患者肝功能障碍(转氨酶增高及／或胆红素增高)，21．8％患者血浆白蛋白减低。痰涂片抗酸杆菌阳性率24．36％，73．1％PPD皮试为阴性。5．57．7％患者并发肺外结核，20．51％合并非结核病。6．以联合抗结核治疗，不同并发症及合并病相应治疗，除1例并发结核性脑膜炎死于脑疝外，余皆好转。结论 CMPT是重症肺结核之一，症状严重，并发症及合并症多，强化抗结核治疗，辅以不同并发症和合并症的治疗，皆能获得满意疗效。

Clinical research on adult acute miliary pulmonary tuberculosis

Objective To analyze the clinical characteristics of acute miliary pulmonary tuberculosis (AMPT). Methods A retrospective analysis of 78 inpatients (from 1995 to 2001) of AMPT was conducted. Results (1) AMPT was more prevalent in adult than in younger population. It was becoming increasingly prevalent among elder population though. (2) 58.97% of the total study sample had the diagnosis confirmed within 30 days after the first appearance of symptoms. Only a few patients got confirmed after 60 days of their symptom appearance. (3) The disease had shown systemic symptoms, predominantly with fever (88.6%),. The primary symptoms shown in respiratory system were cough, expectoration and dyspnea. (4) Lab results: Most patients showed normal values or some increase of the count of peripheral white blood cells (WBC). Few showed a decrease of the WBC count. Among the total, 42.25% had hepatic function distrubance (with an increased AST or ALT and/or bilirubin) and 21.8% had a decreased plasma albumin. The sputum smear positive rate (acid fast bacilli) was 24.36%. 73.5% of the patients had PPD skin test negative. (5) 57.7% of the patients had complication of extra-pulmonary tuberculosis and 20.51% with non-tuberculosis diseases. (6) Only one death report from tuberculosis meningitis was reported and the rest had shown positive outcomes afte treatment, indicating an overall satisfactory results achieved.Conclusion AMPT was one of the severe tuberculosis diseases, manifested with serious symptoms, multiple complications of extra- or non-tuberculosis diseases. However, with anti-tuberculosis therapy strengthened and proper concomitant therapy for its complications, the treatment effects can be satisfactory.