不典型干酪性肺炎和大叶性肺炎各28例的临床对比分析  

Comparative Analysis between Atypical Caseous Pneumonia and Lobar pneumonia

作　　者：罗百灵[1] 李秀英[1] 何白梅[1] 

机构地区：[1]中南大学湘雅医院呼吸科,湖南长沙410008

出　　处：《现代生物医学进展》2009年第6期1092-1094,共3页Progress in Modern Biomedicine

摘　　要：目的:通过比较干酪性肺炎和大叶性肺炎的临床资料,为两种病的鉴别诊断提供依据。方法:收集了2005年到2008年的病例各28例,从临床表现、影像学资料、病原学资料及治疗情况等方面进行回顾性研究比较。结果:①干酪性肺炎的病程较长,在发生明显的症状之前,有一个比较隐匿的长程低热和咳嗽;而大叶性肺炎的病程在一周左右。②大叶性肺炎的咯血(其中包括咯铁锈色痰)和血象的发生率明显高于干酪性肺炎(P<0.05);而干酪性肺炎的PPD结果阳性强度高于大叶性肺炎(P<0.05)。③大叶性肺炎多发于双下肺,以渗出为主,抗生素治疗有效;干酪性肺炎多发于双上肺,以渗出和干酪性病变为主,干酪性肺炎在肺影像学的高密度影可以不均匀,而且可有卫星灶和空洞,且抗感染治疗无效。结论:大叶性肺炎和干酪性肺炎在临床上鉴别诊断较难,干酪性肺炎的误诊率高,详细询问病史和影像学检查可能更利于鉴别诊断。Objective： To compare the clinical data of lobar pneumonia and caseous pneumonia, and to lay foundation for the differential diagnosis for the two diseases. Methods： 28 cases of each disease were collected in Xiangya Hospital from 2005 to 2008,and retrospectively comparing and analysing the clinical performance, x-ray information, laboratory examination and therapy of the patients. Results：① The course of caseous lobar pneumonia was usually longer, and there were a hidden long-range of low fever and cough before obvious symptoms; while the course of lobar pneumonia was about a week.②As to the incidence of hemoptysis （including rust colored sputum） and the count of peripheral white blood cells （WBC） increased, lobar pneumonia was significantly higher than caseous lobar pneumonia （P〈0.05）; while the positive rate of PPD （Purified Protein derivative） skin test of caseous lobar pneumonia was higher than that of lobar pneumonia （P〈0.05）. ③The lesions of lobar pneumonia were usually in the lower lobes, most of which were exudation. The antibiotic treatment is effective. The lesions of caseous lobar pneumonia were usually in the upper lobes, most of which were exudation and cheese lesion. The high-density shadow in lung imaging may be uneven, with calcifed foci and cavities, and it is invalid to apply antibiotic treatment. Conclusions： The differential diagnosis is difficult between lobar pneumonia and caseous lobar pneumonia, and the rate ofmisdiagnoses is high. Inquiring about the history in detail and imaging may be more conducive to the differential diagnosis.

关 键 词：肺炎 大叶性 干酪性肺炎 

分 类 号：R521.9[医药卫生—内科学] R563.11[医药卫生—临床医学]