69例支气管结核临床分析  

Clinical analysis of 69 cases with endobronchial tuberculosis

作　　者：杜昀泽[1] 王枢传[2] 董志云[3] 

机构地区：[1]天津市第二中心医院,天津300120 [2]天津市红十字医院,天津300130 [3]天津市肺科医院,天津300051

出　　处：《中国防痨杂志》2002年第1期9-11,共3页Chinese Journal of Antituberculosis

摘　　要：目的　探索支气管结核早期确诊手段及临床特征。方法　分析 6 9例经纤维支气管镜 (纤支镜 )确诊的支气管结核患者临床表现、胸部X线、CT及纤支镜结果。结果　 6 9例主要症状包括 :咳嗽 6 8例 ,咳痰 4 4例 ,午后低热 5 0例 ,盗汗 4 9例 ,乏力 4 8例 ,喘息 18例 ,痰中带血 13例。胸片及CT示 :气管开口凹凸不平、不规则狭窄 4 2例 ,有阻塞性肺炎 2 6例 ,肺不张 2 5例 ,肺内空洞 14例 ,肺门淋巴结肿大 11例。痰涂片结核菌阳性率为 4 3.5 % ,痰结核菌培养阳性率 36 .2 %。纤支镜示 :刷检结核菌阳性率为 5 5 .1% ,组织活检中 5 6 .7%证实为结核 ,其中 4 0 .6 %为炎症浸润型 ,13.0 %为增殖型 ,2 9.0 %为溃疡型 ,2 6 .1%为狭窄闭塞型。上述四种类型发现结核菌的阳性率分别为 71.4 % ,77.8% ,10 0 %和 5 5 .6 %。结论　当有支气管结核临床表现时 ,应行胸部X线、CT检查 ,对可疑病人作纤支镜。当病理、细菌学均不能明确诊断 ,应重复活检、刷检和试验性抗结核治疗 。Objective To find out the clinical features of endobronchial tuberculosis and approaches to its early diagnosis.Methods Clinical symptoms,chest X-ray/CT scans and fiberoptic bronchoscopic (FB) findings of 69 cases with endobronchial tuberculosis were analyzed.Results Main symptoms were as follows:68 had cough,44 had expectoration with sputum,50 had light fever after noon,49 had night sweat,48 had asthenia,18 had breathlessness,13 had blood-stained sputum.Chest X-ray and CT demonstrated:42 cases showed uneveness and irregular narrowing of the inner bronchial wall,26 cases showed obstructive pneumonia,25 cases showed atelectasis,14 cases showed pulmonary cavity,11 cases showed hilar lymphadenovarix.Positive sputum smear and culture for acid-fast bacilli (AFB) were 43.5% and 36.2%,respectively.Staining for AFB was 55.1% positive in bronchial washings and diagnosis was confirmed by bronchoscopic biopsy specimens in 56.7%.Bronchoscopic results showed exduative lesions in 40.6% of the cases,granulomatous in 13.0%,ulcerative lesions in 29.0% and cicatricial lesions in 26.1%.Positive ratio of found AFB for the four subtypes were 71.4%,77.8%,100% and 55.6%,respectively.Conclusion We should select patients by chest X-ray when they have clinical manifestation as described above and CT were examed for the observed lesions.Bronchoscopic was done when the patients were suspected.When endobronchial tuberculosis couldn't be confirmed by pathology and bacteriology,the follow-up bronchoscopic biopsy,brushing examination and anti-tuberculosis treatment should be repeatedly preformed until the diagnosis was confirmed by the follow observation.

关 键 词：支气管结核 CT 支气管镜检 早期诊断 临床特征 

分 类 号：R521[医药卫生—内科学] R816.4[医药卫生—临床医学]