31例肺曲霉菌病误诊为肺结核原因分析

目的　分析肺曲菌病患者的临床特征及误诊原因。方法 对误诊为肺结核并经手术病理证实为肺曲菌病的31例病例进行回顾性分析。结果 男性20例,女性11例,年龄17～55岁,平均35.8岁,病程6月～20年,平均36.8月。主要症状为咳嗽、咯痰28例次,占90.3%,咯血29例次,占93.5%,发热9例次,占29%。胸部X线表现为团块或结节影12例,占38.7%,均为单发;形态各异的片状、条索状阴影17例,占54.8%;一侧肺损毁2例,占6.45%;有典型“新月征”表现18例,占58%。病变位于上叶尖后段、下叶背段及一侧肺24例,占77%。所有病例痰结核菌检查均阴性,经正规抗结核及抗炎治疗,其中6例术前曾抗真菌治疗,病情变化不明显。结论 误诊原因主要是肺曲霉菌病与肺结核病的临床表现及X线表现相似,痰曲霉菌检查阳性率低。部分病例既往有肺结核病史,如病情有变化,易认为是结核复发。因此对反复咯血、抗结核治疗效果不佳或X线胸片有“新月征”表现者应想到肺曲霉菌病,如果有条件者及时手术治疗。

Analysis on the reasons of 31 pulmonary aspergillosis cases misdiagnosed as tuberculosis

Objective To analyse the clinic characters and the misdiagnosis reasons of pulmonary aspergillosis patients. Methods An retrospective study was carried out in 31 cases that have been misdiagnosed as tuberculosis(TB) and finally diagnosed aspergillosis by operation. Result There were 20 male patients and 11 female patients, whose age from 17 to 55 years old and average age was 35.8.The duration of illness from 6 months to 20 years, mean duration was 36.8 months. The cardinal symptoms were cough and sputum accounting for 90.3% and haemoptysis accounting for 93.5%. Analysing the images, there were 12 cases with ball or node in X-ray and all were single. There were 17 cases with differently sheet and streaky shadow in X-ray, there were 2 cases with one lung destroyed, there were 18 cases with "new moon"signs accounting for 58%. The pathological changes usually locates in the upper and under lobar and single lung, which are the frequently place that TB happened (accounting for 77%). The sputum test of all cases were negative, by giving normally therapy of anti-TB and anti-inflammation, and the state of illness of all cases were unconspicuous after therapy, including 6 cases that treated with antigungal before operation. Conclusion The misdiagnosis reasons were that the clinic and X-ray exhibitions of TB were similar to that of aspergillosis. The positive of sputum test for aspergillosi was low. With the effect of old TB history, if the state of illness were changed, it easily mistook as TB recurred. If the patient whose chest X-ray has "new noon"signs has repeated cough and sputum and the effect of antituberculosis is not good, we should think of aspergillosi and operated in time on these patients.