412例初治菌阴肺结核临床分析

目的探讨菌阴肺结核临床特点和相关诊断方法。方法对2004年6月-2006年2月间诊断初治菌阴肺结核412例进行总结分析，对其临床表现、X线特征等动态观察，治疗前及治疗2、5、6个月末各查痰涂片3张，治疗前痰菌培养1次，同时进行结合抗体及PPD检测。结果菌阴肺结核临床症状以咳嗽咳痰、乏力、盗汗为主，但症状轻微，另11．4％无任何症状在体检时发现。常规剂量全程抗结核治疗后，临床症状改善及X线吸收好转率达到98．3％。结论菌阴肺结核临床症状轻微，X线胸片是诊断菌阴肺结核重要手段之一。结合相关实验室检查并排除其他疾病而综合判定，6个月方案对菌阴病人是可取的，91．5％病例病灶有较明显吸收。

The clinical analysis on 412 primary smear and culture negative pulmonary tuberculosis cases

Objective To discuss the clinical characters and diagnosis methods of primary smear and culture negative pulmonary tuberculosis cases. Methods The clinical characters of 412 cases primary smear and culture negative pulmonary tuberculosis cases from Jun. 2004 to Feb. 2006 were reviewed and analyzed , and the clinical showings and X-rays features of the 2 years were dynamically observed. Sputum were checked for three times, namely before the treatment and at treatment of 2nd, 5th, 6th month. Sputum culture was made before the treatment. Meanwhile, the patients received anti-tuberculosis antibody test and PPD test. Results The clinical symptoms of primary smear and culture negative pulmonary tuberculosis cases are mainly slight coughing, flaccid and night sweating. Nothing was found on another 11.4% cases in physical examinations. Through the whole procedure of anti-tuberculosis treatment with common dosage, the rate of symptom improvement, assimilation of cavity and function recovery shown by X-rays was 98.3 %. Conclusion Sputum negative pulmonary tuberculosis can be diagnosed in a comprehensive way. Coughing, flaccid, emptysis, low fever and night sweating are the clues combined with X-rays and laboratory examination. X-rays is one of the important methods to diagnose sputum negative pulmonary tuberculosis. After treatment, the most ideal outcome is tuberculosis assimilated wholly, followed by tuberculosis assimilated with cavity, and tuberculosis assimilated with scobination. The 6-month regimen is available in treating the primary smear and culture negative pulmonary tuberculosis patients.