肺结核治愈但致肺结构性损坏后咳嗽咳痰患者的综合特征  

Comprehensive characteristics of cases with cough,expectoration and history of successful treatment of pulmonary tuberculosis but structural lung damage

作　　者：方伟明 汤春梅[2] 肖海浩[2] 张言斌[2] FANG Weiming;TANG Chunmei;XIAO Haihao;ZHANG Yanbin(Guangzhou Medical University,Guangzhou 511436,China;不详)

机构地区：[1]广州医科大学,广州511436 [2]广州市胸科医院,广州510095

出　　处：《实用医学杂志》2020年第9期1203-1208,共6页The Journal of Practical Medicine

基　　金：“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项(编号:2018ZX10715004)。

摘　　要：目的探索影响肺结核治愈但有肺结构性损坏后咳嗽咳痰患者诊断与鉴别诊断的重要因素。方法收集2018年1-12月在广州市胸科医院住院的305例肺结核治愈但有肺结构性损坏、后又因咳嗽咳痰住院治疗患者的临床资料,回顾性分析患者的年龄、性别、基础性疾病(高血压、糖尿病、慢性阻塞性肺病、支气管张等)、临床症状、胸部影像学、病原学等特征。结果肺部感染、肺结核再发、肺曲霉菌病、非结核分枝杆菌肺病的比例分别为48.52%(148/305)、28.85%(88/305)、13.11%(40/305)和9.51%(29/305),57.70%(176/305)的患者具有支气管张症;4种疾病的男女性别发生率比值分别为1.00 vs.1.38、1.47 vs. 1.00、5.00 vs. 1.00和1.00 vs. 2.00,青年(≤44岁)、中年(45(59岁)、老年(≥60岁)3年龄组发生率比值分别为(1.00∶1.67∶2.13)、(2.00∶1.10∶1.00)、(4.05∶3.03∶1.00)和(0∶1.00∶1.25);呼吸困难、咯血、肺部啰音、发热为主要临床症状和体征,分别占病例总数的42.95%(131/305)、41.64%(127/305)、35.41%(108/305)和20.00%(61/305),其中95.00%(38/40)的肺曲霉菌病患者具有咯血症状;影像学主要表现为密度增高影、钙化、肺大泡、气管偏移、厚壁空洞、胸腔积液、新月征等,分别占病例总数的98.36%(300/305)、75.74%(231/305)、45.90%(140/305)、43.28%(132/305)、41.31%(126/305)、9.18%(28/305)和3.28%(10/305),其中90.00%(9/10)的新月征影像为肺曲霉菌病患者所呈现;病原学或病理学确证率分别为21.62%(32/148)、100%(88/88)、100%(40/40)和100%(29/29)。结论肺结核治愈但致肺结构性损坏后咳嗽、咳痰患者的综合特征是有相类似的临床表现及不易鉴别的影像学表现,所以对于肺结核治愈但有肺结构性损坏后再次出现咳嗽咳痰患者,不能因为具有与结核病相类似的临床症状和影像学表现、更不能因为其有结核病史盲目确立结核病诊断,而应力争获取病原学或病理学证据予以诊断�Objective To explore the important factors that influence the diagnosis and differential diagnosis of cases with cough,expectoration and history of successful treatment of pulmonary tuberculosis but structural lung damage.Methods The clinical data of 305 cases with cough and expectoration hospitalized in Guangzhou Chest Hospital from January 2018 to December 2018,whose pulmonary tuberculosis had been successfully treated but lung structure had been damaged to some degree,were collected. The age,sex,underlying diseases including hypertension,diabetes,chronic obstructive pulmonary disease,bronchiectasis,etc.,clinical symptoms,imaging of chest and pathogen were analyzed retrospectively.Results There were four kinds of diseases,namely,lung infection,recurrence of tuberculosis,pulmonary aspergillosis and non-tuberculous mycobacterial lung diseases. The proportion of these cases accounted for 48.52%(148/305),28.85%(88/305),13.11%(40/305),and 9.51%(29/305)respectively and 57.70%(176/305)of all cases had bronchiectasis. The ratios of male to female were1.00 vs. 1.38,1.47 vs. 1.00,5.00 vs. 1.00 and 1.00 vs. 2.00 respectively. The ratios of incidence among the young age group(≤ 44 years),middle age(45(59 years)and elderly(≥ 60 years)were(1.00∶1.67∶2.13),(2.00∶1.10∶1.00),(4.05∶3.03∶1.00)and(0∶1.00∶1.25)respectively. The main clinical symptoms and signs were dyspnea(accounting for 42.95%),hemoptysis(accounting for 41.64%),pulmonary rales(accounting for 35.41%)and fever(accounting for 20.00%). Especially,95.00%(38/40)of cases with pulmonary aspergillosis had hemoptysis. The main imaging included increased density,calcification,bullae,tracheal deflection,thick-walled cavities,pleural effusion and crescent sign,and they accounted for 98.36%(300/305)and 75.74%(231/305),45.90%(140/305),43.28%(132/305),41.31%(126/305),9.18%(28/305),and 3.28%(10/305)respectively. It was worth noting that 90%(9/10)of the crescent sign images were presented in cases with pulmonary aspergillosis. Diagnosis rates by pathogen or path

关 键 词：肺结核 肺结构性损坏 肺部感染 肺曲霉菌病 非结核分枝杆菌肺病 

分 类 号：R521[医药卫生—内科学]