慢性血行播散性肺结核一例并文献复习  

Chronic hematogenous disseminated tuberculosis:a case report and literature review

作　　者：叶熊 肖辉[2] 金宇飚[3] 郭海英[2] Ye Xiong;Xiao Hui;Jin Yubiao;Guo Haiying(School of Clinical M edicine,Shanghai University o f Medicine Health Science,Shanghai 201318,China;Department of Respiratory and Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;Department of Pathology,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China)

机构地区：[1]上海健康医学院临床医学院,201318 [2]上海交通大学附属上海市第一人民医院呼吸与危重症医学科,200080 [3]上海交通大学附属上海市第一人民医院病理科,200080

出　　处：《国际呼吸杂志》2020年第21期1636-1641,共6页International Journal of Respiration

基　　金：上海市卫生健康委员会资助项目(201740227);国家自然科学基金青年项目(81701547)。

摘　　要：目的:提高对慢性血行播散性肺结核的认识和诊断水平。方法:报道1例慢性血行播散性肺结核的临床表现、诊治经过并进行系统性的文献复习。以"慢性血行播散性肺结核"和"不典型血行播散性肺结核"为关键词检索中国知网;以"chronic hematogenous disseminated tuberculosis[Title/Abstract]"为检索式检索PubMed数据库,检索时间截至2019年11月。结果:本例患者男,80岁,因"反复咳嗽、咳痰半年余"行胸腔镜下胸膜结节活检,术后病理证实为慢性血行播散性肺结核。中国知网数据库检索出11篇,PubMed检索到7篇相关文献,经筛选剔除重复发表,共34例患者进入本研究。本病起病隐匿,症状和胸部影像表现不典型,且病原学检出率低,误诊率达44.4%,部分患者通过尸检才明确诊断。文献报道的确诊患者往往患有以下基础疾病,如糖尿病、血液病、人类免疫缺陷病毒感染/获得性免疫缺陷综合征、各种非获得性免疫缺陷综合征性免疫缺陷包括结缔组织病和器官移植术后。结论:临床医师应提高对慢性血行播散性肺结核的认识和警惕性,特别是当合并糖尿病、免疫缺陷等基础疾病时,应高度怀疑本病的可能。Objective To improve recognition and diagnosis level of chronic hematogenous disseminated tuberculosis.Methods The clinical manifestation,diagnosis,and treatment of a case of chronic hematogenous disseminated tuberculosis were reported.CNKI was retrieved with"chronic hematogenous disseminated tuberculosis"or"alypical hemat ogenous disseminated tuberculosis"PubMed database was retrieved with"chronic hematogenous disseminated tuberculosis[Title/Abstract]".The search time was up to November 2019.Results A 80-year old male,who had cough and sputum for more than half a year,underwent thoracoscopy for pleural nodules.Postoperative pathology confirmed chronic hematogenous diss eminated tuberculosis.Eleven related articles were retrieved from CNKI and seven from PubMed.After exclusion of the repeated publication,34 patients were included in this study.Due to the insidious onset,the symptoms and pulmonary imaging manifestations were atypical,and the etiology detection rate was low,the misdiagnosis rate was 44.4%.The diagnosis of some patients was confirmed through autopsy.The confirmed patients reported in the literatures often suffered from the following underlying diseases,such as diabetes,blood diseases,human immunodeficiency virus infection/aquired immune deficiency syndrome,various non-aquired immune deficiency syndrome immunodeficiency including conective tissue diseases and organ transplantation.Conclusions Clinicians should increase awareness and vigilance of chronic hematogenous disseminated tuberculosis.The possibility of tuberculosis should be highly suspected,especially for patients combined with diabetes and immunodeficiency diseases.

关 键 词：慢性血行播散性肺结核 不典型血行播散性肺结核 胸膜结节 结核 肺 

分 类 号：R521[医药卫生—内科学]