支气管黏膜角化症并发支气管结核一例并文献复习

分析陕西省结核病防治院收治的1例支气管黏膜角化症患者的临床资料及诊治经过,并搜集相关文献进行复习。患者为1例27岁男性农民,收治于2014年1月26日,临床表现主要为咳嗽、咳痰、胸痛、呼吸困难,胸部CT检查未见活动性病灶,行纤维支气管镜检查显示大量黄色胎膜样物质附着,痰结核分枝杆菌培养阳性。纤维支气管镜下病理检查显示,支气管黏膜表面覆盖鳞状上皮伴角化过度,符合支气管黏膜角化症并发支气管结核的诊断。给予异烟肼、利福平、吡嗪酰胺、乙胺丁醇进行抗结核药物治疗,同时给予碳酸氢钠、地塞米松及重组人表皮生长因子反复在支气管镜下灌洗并进行冷冻治疗,6个月后镜下附着物完全吸收。随访4年,患者工作、生活正常。作者综合文献分析,认为支气管黏膜角化症并发支气管结核临床症状和特征缺乏特异性,确诊主要依靠病史及病理诊断;可根据患者的具体情况,实施抗结核药物治疗,以及联合纤维支气管镜冷冻、镜下给药治疗等,患者可以得到治愈。

Bronchial mucosa keratosis combined with bronchial tuberculosis: a case report and literature review

A case diagnosed as bronchial mucosa keratosis combined with bronchial tuberculosis was reported by Shaanxi Provincial Tuberculosis Hospital and the related clinical information and process for diagnosis and treatment of this patient were analyzed, the relevant literature was reviewed as well. The patient was a 27 years old man, a farmer. He was admitted to the hospital on January 26th, 2014 presenting with fever, cough with sputum, chest pain and dyspnea. No active lesions were seen in chest CT. The fiberoptic bronchoscopy examination showed a large amounts of yellow membranous attachments. Sputum Mycobacterium tuberculosis culture was positive. Pathological examination under fiberoptic bronchoscopy showed that the surface of bronchial mucosa was covered with squamous epithelium combined with hyperkeratosis, which was in accorded with the diagnosis of bronchial mucosal keratosis complicated with bronchial tuberculosis. Anti-TB drugs, isoniazid, rifampicin, pyrazinamide and ethambutol, were given to the patient for anti-tuberculous treatment. At the same time, sodium bicarbonate, dexamethasone and recombinant human epidermal growth factor were repeatedly lavaged under bronchoscopy and bronchoscopic cryo-therapy was also performed. After six months, the attachments were completely absorbed. Four years follow-up was done to this patient, and he had normal work and life. Based on the literature review results, the authors think that the clinical symptoms and signs of bronchial mucosal keratosis complicated with bronchial tuberculosis are lack of specificity. The diagnosis mainly depends on the history and pathological examination. According to the specific situation of the patients, anti-tuberculosis treatment can be implemented, as well as combined fiberoptic bronchoscope cryotherapy and bronchoscopic administration, etc, to cure the patients.