继发性肺结核和成人支原体肺炎的临床诊断与鉴别诊断  

Clinical diagnosis and differential diagnosis of secondary pulmonary tuberculosis and adult mycoplasma pneumonia

作　　者：王巍 陈红兵 李净 王波 

机构地区：[1]解放军第三〇九医院全军结核病研究所,北京100091 [2]解放军第三〇九医院结核四科,北京100091

出　　处：《中国防痨杂志》2012年第4期233-236,共4页Chinese Journal of Antituberculosis

摘　　要：目的通过比较继发性肺结核和成人支原体肺炎的临床资料,为两种疾病的鉴别诊断提供依据。方法收集解放军第三〇九医院2008年1月至2010年12月的部分(排除病案资料不全者)继发性肺结核患者67例和成人支原体肺炎患者32例,从临床表现、影像学资料和治疗效果等方面进行回顾性研究比较。结果与继发性肺结核患者相比:(1)成人支原体肺炎患者起病急者(<1d)较多(占87.5%,28/32;继发性肺结核占7.5%,5/67)(χ2=62.3898,P<0.01);呼吸道症状[鼻塞流涕(占68.8%,22/32;继发性肺结核占3.0%,2/67)、头痛(占28.1%,9/32;继发性肺结核占6.0%,4/67)、咽痛(占50.0%,16/32;继发性肺结核占4.5%,3/67)]明显者较多(χ2=51.1830,χ2=9.2565,χ2=30.8682,P值均<0.01);多数患者肺部可闻及湿性啰音(占53.1%,17/32;继发性肺结核占13.4%,9/67)(χ2=17.6145,P<0.01)。(2)成人支原体肺炎多数患者影像学表现为磨玻璃样影(占71.9%,23/32;继发性肺结核0例)(χ2=62.7398,P<0.01),以两肺中下野多见(占70.0%,14/20;继发性肺结核占34.2%,13/38)(χ2=9.5139,P<0.01),病灶呈游走性者较多(占9.4%,3/32;继发性肺结核0例)(χ2=5.9103,P<0.05);抗感染治疗后(阿奇霉素或红霉素)多数患者肺内病灶多在2周内消散吸收(占53.1%,17/32;继发性肺结核0例)(χ2=42.8718,P<0.01)。(3)支原体肺炎红细胞冷凝集试验多呈阳性(占71.9%,23/32;继发性肺结核0例;χ2=62.8571,P<0.01);肺炎支原体抗体IgM也多呈阳性(占81.3%,26/32;继发性肺结核占1.5%,1/67;χ2=67.5228,P<0.01)。结论继发性肺结核和成人支原体肺炎鉴别诊断应详细分析病史,注意影像学病灶特征,试验性治疗和多次血清学检查有助于鉴别诊断。Objective To compare the clinical data of secondary pulmonary tuberculosis and adult mycoplas- mal pneumonia and to lay foundation for the differential diagnosis for the 2 diseases. Methods Sixty-seven cases and 32 cases of the 2 diseases were collected in our hospital from 2008 to 2010, and the clinical performance, X-ray information, laboratory examination and therapy of the patients were retrospectively analyzed. Results （1）The course of most aduh mycoplasmal, pneumonia patients was usually shoter（87.5% ,28/32）than secondary pulmonary tuberculosis patients（7.5%, 5/67） （X^2= 62. 3898, P〈0.01 ）, and symptoms of respiration [runny nose （68. 8 %, 22/32）, headache （28. 1%, 9/32）, sore throat （ 50. 0%, 16/32）3 were more common than those of patients with secondary pulmonary tuberculosis （3.0 % （2/67 ）, 6.0 % （4/67 ）, 4.5 % （3/67 ）） （X^2= = 51.1830, ）X^2= 9.2565, X^2=30. 8682,All P〈0. 01）. The sign ot rale was iound more m mycoplasmal pneumoma patmnts （5301%,17/32）than that in secondary pulmonary tuberculosis patients（13.4%, 9/67）（X^2=17. 6145, P〈0. 01）. （2）The most common CT finding of adult mycoplasmal pneumonia were ground glass opacity and consolidation（71.9 %, 23/32）,with none of secondary pulmonary tuberculosis patients（X^2=62. 7398 ,P〈0. 01）. Most of the ground glass opacity and consoli- dation showed tendency of lobular distribution and involving the lower lobes（70. 0%, 14/20）in patients with myeo- plasmal pneumonia, while secondary pulmonary tuberculosis patients was 34.2% （13/38） （X^2= 9. 5139, P〈0. 01）. In some patients with mycoplasmal pneumonia, the focus was wandering（9.4%,3/32）, while secondary pulmonary tuberculosis patients was not found （X^2=5. 9103,P^0.05）. The lesions was absorbed after treatment with azithro- mycin or erythrocin in 4 weeks（53.1%,17/32）in mycoplasmal pneumonia, but that could not be seen in secondary pulmonary tuberculosis patients （X^2=42. 8718,P〈0.01）. （3） Serum

关 键 词：结核 肺/诊断 肺炎 支原体 诊断 鉴别 

分 类 号：R725.6[医药卫生—儿科]