牛型分枝杆菌肺结核25例临床特征及诊治分析  

Analysis on clinical features,diagnosis and treatment for 25 patients with mycobacterium bovis pulmonary tuberculosis

作　　者：刘裔 吴志嵩 韩红洋 茅惠娟 马南兰 LIU Yi;WU Zhi-song;HAN Hong-yang;MAO Hui-juan;MA Nan-lan(The Second Hospital of Nanjing’Jiangsu 210000,China)

机构地区：[1]南京市第二医院,江苏210000

出　　处：《医学动物防制》2021年第4期394-397,共4页Journal of Medical Pest Control

摘　　要：目的探讨牛型分枝杆菌肺结核的临床特征、影像学表现、治疗方法及预后。方法回顾性分析某院结核科2017年4月-2019年8月收治的25例牛型分枝杆菌肺结核患者资料,对临床症状、影像学结果、实验室检查结果、结核类型以及治疗情况等资料进行总结分析。结果25例牛型分枝杆菌肺结核患者中,男性12例、女性13例,平均年龄46.2岁,人与人之间的传播是主要的传播途径,咳嗽咳痰症状为主要表现;牛型分枝杆菌肺结核影像学特点为多累及两肺、三个及以上肺叶,纵膈淋巴结肿大风险高;结核感染T-SPOT检测阳性率达到90%;所有患者中20例行纤支镜检查,其中15例确诊气管支气管结核患者,未行纤支镜者有4例合并其他部位结核;25例患者的治疗以异烟肼+利福平为核心药物,加用乙胺丁醇和(或)左氧氟沙星方案进行治疗,除1例继发淋巴瘤转肿瘤科就诊外,其余患者病情均有明显好转。结论重视人与人之间传播牛型分枝杆菌风险,积极完善影像学及实验室检查明确结核病病原体,对于咳嗽咳痰症状明显的患者需要排除支气管结核,通过积极治疗预后满意。Objective To explore clinical features,imaging findings,therapeutic methods and prognosis of mycobacterium bovis pulmonary tuberculosis.Methods Twenty five patients with mycobacterium bovis pulmonary tuberculosis admitted to the Tuberculosis Department of the hospital from April 2017 to August 2019 were retrospectively analyzed,and clinical symptoms,imaging features,laboratory examination results,tuberculosis types and treatment conditions of patients were subject to the summary analysis.Results There were 12 male and 13 female,patients with an average age of 46.2 years in 25 patients with mycobacterium bovis pulmonary tuberculosis,the human-to-human transmission was considered to be main route of transmission,the cough and expectoration symptoms served as main symptoms;the imaging features of mycobacterium bovis tuberculosis were found to be further complicated with two lungs or have three or more lung lobes invaded,the risk of mediastinal lymphadenopathy was high;T-SPOT positive rate of tuberculosis infection was 90%;20 out of all patients underwent fiberoptic bronchoscopy,15 patients were diagnosed with tracheobronchial tuberculosis,and 4 patients without bronchoscopy were found to have the tuberculosis in other sites;25 patients were treated with isoniazid+rifampicin as the core drugs,plus ethambutol and(or)levofloxacin regimen,and the remaining patients were improved significantly except one patient developed into lymphoma.Conclusion It is to take note of the human-to-human risk of transmission of mycobacterium bovis and actively improve imaging and laboratory tests to identify tuberculosis pathogens.The patients with remarkable symptoms like the cough and expectoration are required to exclude bronchial tuberculosis,and satisfactory prognosis may be achieved through active treatment.

关 键 词：牛型分枝杆菌 肺结核 临床特点 治疗方案 感染 

分 类 号：R521[医药卫生—内科学]