1例继发性肺结核合并新型冠状病毒肺炎的病例报道

探讨继发性肺结核合并新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）的早期诊断和治疗。回顾性分析武汉市肺科医院收治的1例继发性肺结核合并COVID-19患者的临床表现、辅助检查及诊治经过。患者有明确的COVID-19的接触史,临床表现为咳嗽、咳痰,发热及气喘,胸部CT可见双肺散在多发的斑片、结节、斑点、条索及空洞影。通过呼吸道标本新型冠状病毒核酸检测尽早确诊了COVID-19,通过合理的抗结核联合抗病毒治疗后,呼吸道标本新型冠状病毒核酸及痰标本结核细菌涂片转阴,症状缓解出院。在COVID-19流行时期,需注意鉴别继发性肺结核合并COVID-19情况,以及治疗两种疾病药物方案的制定,避免使用肝药酶诱导剂利福平,其会使克力芝（洛匹那韦/利托那韦）、阿比多尔等药效减弱贻误治疗。

A case report of secondary pulmonary tuberculosis complicated with COVID-19

To investigate the early diagnosis and treatment of secondary tuberculosis complicated with COVID-19. The clinical manifestation, auxiliary examination, diagnosis and treatment of one case of secondary tuberculosis complicated with COVID-19 admitted to Wuhan Pulmonary Hospital were analyzed retrospectively. The patient had a clear history of COVID-19 exposure. The clinical manifestations were cough, expectoration, fever and gasp. Chest CT showed multiple patch, nodule, spot, strip and cavity shadow in two lungs. COVID-19 was diagnosed as early as possible by detection of SARS-CoV-2 nucleic acid in respiratory specimens. After reasonable anti-tuberculosis combined with antiviral treatment, the detection of SARS-CoV-2 nucleic acid in respiratory specimens and acid-fast bacilli smear of sputum specimens turned negative, the symptoms were relieved and discharged. In the epidemic period of COVID-19, we should pay attention to the identification of secondary pulmonary tuberculosis with COVID-19, the formulation of drug programs for the treatment of two diseases, and avoid the use of rifampicin, a liver drug enzyme inducer, so as to avoid missed treatment due to the weakened efficacy of lopinavir / ritonavir and abidol, etc.