30例肝脏结核临床诊治分析  

Clinical analysis of 30 patients with hepatic tuberculosis

作　　者：王小娟 梁树辉 刘清 WANG Xiao-juan;LIANG Shu-hui;LIU Qing(Department of Gastroenterolog,Xi’an Honghui Hospital;Department of Gastroenterology,the First Affiliated Hospital of Air Force,Medical University)

机构地区：[1]陕西西安市红会医院消化内科,陕西710054 [2]空军军医大学第一附属医院消化内科

出　　处：《肝脏》2020年第9期959-960,1010,共3页Chinese Hepatology

基　　金：国家自然科学基金面上项目(81571731)。

摘　　要：目的分析肝脏结核的临床特点、实验室检查、诊断方法,减少误诊漏诊。方法回顾性分析2000年1月至2020年1月空军军医大学第一附属医院收治的30例肝脏结核患者的病史、临床表现、实验室检查、影像学检查,肝脏病理。结果 30例患者中,发热24例,右上腹隐痛19例,腹胀21例,体质量下降22例;实验室检查贫血17例,白细胞降低9例,白细胞升高11例;红细胞沉降率增快者20例,腺苷脱氨酶(ADA)升高14例,乳酸脱氢酶升高者11例。T-SPOT·TB阳性18例,PPD皮试阳性13例。所有患者均有不同程度肝功能异常。影像学检查可见各种类型肝内病变。超声引导下肝脏穿刺活检病理确诊23例,外科手术病理诊断2例。结论肝脏结核临床表现多样,缺乏特异性实验室诊断指标,其诊断需要综合分析,影像学结合肝脏病理组织学检查有助于诊断肝结核。Objective To summarize the clinical characteristics,examinations and diagnosis of hepatic tuberculosis.Methods The clinical data of patients with hepatic tuberculosis treated in our hospital from January 2000 to January 2020 were retrospectively analyzed.Results Among the 30 patients with hepatic tuberculosis,there were 24 cases with fever,19 cases with obscure pain in the right upper abdomen,21 cases with abdominal distension,and 22 cases with weight loss of 3-7 kg.Laboratory examinations showed 17 cases with anemia,9 cases with decreased leukocyte,11 cases with increased leukocyte,20 cases with increased erythrocyte sedimentation,14 cases with increased adenosine deaminase and 11 cases with increased lactate dehydrogenase.There were 18 T cell spot test positive cases and 13 purified protein derivative skin test positive cases.Liver function test indicated that all patients had different degrees of liver dysfunction.Imaging examinations showed various types of intrahepatic lesions.In the 30 patients,there were 23 cases pathologically diagnosed by ultrasound-guided liver biopsy,and 2 cases pathologically diagnosed by surgery.Conclusion Hepatic tuberculosis has diverse clinical manifestations,with lack of specific diagnostic laboratory indicators.Therefore,its diagnosis needs comprehensive analysis.Imaging combined with liver histopathological examination is the main method to diagnose hepatic tuberculosis.

关 键 词：肝脏结核 诊断 病理 

分 类 号：R525[医药卫生—内科学]