发生于结核性胸膜炎抗痨过程中的类赫反应  

Paradoxical response in patients with isolated pleural tuberculosis

作　　者：胡良安[1] 傅玉[1] 张杰[1] 

机构地区：[1]重庆医科大学附属第一医院,重庆400016

出　　处：《中国老年学杂志》2013年第10期2238-2240,共3页Chinese Journal of Gerontology

基　　金：重庆市自然科学基金资助项目(No.CSTC2007BB5293)

摘　　要：目的探讨结核性胸膜炎抗痨过程中发生类赫反应(PR)的频率、临床特点及其危险因素。方法采用病历资料的回顾性列队研究。结果符合条件的527例结核性胸膜炎患者抗痨后80例发生PR(15%),发生PR的时间是抗痨后(54±38)d。发热(36%)和呼吸困难(30%)是PR的最常见症状。80例PR误诊为耐药结核26例(33%),肺炎12例(15%)和肺癌7例(9%)。发生PR的危险因素是:年龄较年轻、低蛋白血症,以及胸液中白细胞总数较低、淋巴细胞比例较低和中性粒细胞比例较高(P<0.05)。结论在结核性胸膜炎患者抗痨中出现PR不是不常见的现象,且易误诊,因此,医生对在结核性胸膜炎患者抗痨过程中发生PR的可能情况必须高度重视。Objective To evaluate the incidence, clinical characteristics and predicting factors for the development of paradoxical response （PR） in patients with isolated pieural tubercu!osis（TB）. Methods A retrospective cohort study including 527 patients who were diagnosed and treated with isolated pleural TB was executed. Results PR was present in 80 （ 15% ） of 527 patients after （54 ＋ 38） days following initiation of treatment. Fever and dyspnoea were the most common symptoms associated with PR. 26 （33%） patients had been ini- tially misdiagnosed of drug-resistant TB, 12（ 15% ） patients had been misdiagnosed of pneumonia and 7 （ 9% ） patients had been misdiag- nosed of lung cancer. The risk factors for PR were younger age, low serum albumin level, low WBC count and proportion of lymphacyte and high proportion of PMN in pleural fluid （P 〈 0. 05）. Conclusions PR is not an uncommon problem in pleural TB and is common misdiag- nosed. Therefore, physicians must pay more attention to PR during the management of pleural TB in the expected patients to develop PR.

关 键 词：结核 胸膜炎 类赫反应 

分 类 号：R521.7[医药卫生—内科学] R181.32[医药卫生—临床医学]