支气管扩张症急性加重合并分枝杆菌感染临床分析  

Clinical analysis of mycobacterial infection in patients with bronchiectasis in exacerbation period

作　　者：王彰晖[1] 叶进湖[2] 刘群[1] 

机构地区：[1]厦门大学附属第一医院呼吸内科,福建厦门361003 [2]厦门大学附属第一医院放射科,福建厦门361003

出　　处：《中国实用医刊》2013年第24期24-26,共3页Chinese Journal of Practical Medicine

基　　金：2010年福建省卫生厅青年科研课题（2010-2-88）

摘　　要：目的 分析住院的支气管扩张急性加重合并分枝杆菌感染患者的临床特点.方法 回顾性分析10例支气管扩张症急性加重合并分枝杆菌感染患者的临床资料.结果 10例患者中男5例,女5例.低体质量指数5例.无吸烟史7例.既往有结核史5例.咳嗽咳痰9例,有咯血史7例,低热5例,体质量减轻5例.湿啰音5例.中性粒细胞升高9例,纤维蛋白原升高6例,血沉升高7例.痰中同时检出其他病原菌4例.CT检查见10例支气管扩张均累及双肺,10例支气管壁均增厚,6例节段性肺不张,8例有细支气管炎特征,7例有局部的慢性纤维化,10例有浸润.心脏彩超提示7例肺动脉收缩压升高.结论 支气管扩张症急性加重时,应警惕分枝杆菌的感染.咯血、低热、低体质量指数、体质量减轻,CT影像学上的细支气管炎、实变、浸润、局部慢性间质纤维化,提示合并分枝杆菌感染.在痰中检出普通病原菌时,仍需警惕合并分枝杆菌感染的可能.Objective To analyze the clinical characteristics of mycobacterial infection in patients with bronchiectasis in exacerbation period.Methods A retrospective analysis of clinical,microbiological and radiology data of 10 patients with bronchiectasis in exacerbation period with positive mycobacterial smear over 4 years was performed.Results Among the 10 patients,there were 5 males and 5 females.Five cases had low body mass index（BMI）,7 cases were never-smokers.Five cases had a history of tuberculosis preceding admission,9 cases had a history of cough and expectoration,7 cases had a history of hemoptysis,5 cases had low-grade fever,5 cases had weight lose.Moist rales in 5 cases,neutrophils increased in 9 cases.Fibrinogen （FIB） increased in 6 cases.Erythrocyte sedimentation rate （ESR） increased in 7 cases.Pathogens besides mycobacteria were detected in 4 cases.Radiological examination showed that all cases had widespread bronchiectasis.Bronchial dilation and infiltrates were in 10 cases,consolidation was in 10 cases,collapse in 6 cases,bronchiolitis in 8 cases,and local chronic interstitial fibrosis in 7 cases.Echocardiography examination revealed 7 cases with elevated pulmonary artery systolic pressure.Conclusions Mycobateria infection should be considered in patients with bronchiectasis in exacerbation period.Hemoptysis,low-grade fever,low BMI and bronchiolitis,consolidation,infiltrates,local chronic interstitial fibrosis in CT may suggest mycobateria infection.When common pathogens are detected in sputum,further examinations are still needed to rule out mycobacteria infection.

关 键 词：支气管扩张 急性加重 分枝杆菌 

分 类 号：R562.22[医药卫生—呼吸系统]