镜下非活动期中心型气管支气管结核的临床表现及影像学特征分析  

Analysis of clinical manifestations and imaging features of inactive central tracheobronchial tuberculosis using microscope

作　　者：郭洋 秦林[1] 徐慧芳 赵营 王文洁[1] 付文侠[1] 王国春[1] 啜峻玮 丁卫民[1] 傅瑜[2] GUO Yang;QIN Lin;XU Hui-fang;ZHAO Ying;WANG Wen-jie;FU Wen-xia;WANG Guo-chun;CHUAI Jun-wei;DING Wei-min;FU Yu(Department of Endoscopic Diagnosis and Treatment,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Clinical Center on Tuberculosis,Chinese Center for Disease Control and Prevention,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院内镜诊疗科,北京101149 [2]中国疾病预防控制中心结核病防治临床中心,北京101149

出　　处：《中国防痨杂志》2022年第4期322-328,共7页Chinese Journal of Antituberculosis

基　　金：北京市临床重点专科项目(20201214)。

摘　　要：目的:探讨不同类型镜下非活动期中心型气管支气管结核(简称“气管支气管结核”)的特征。方法:回顾性分析2017年1月至2020年12月首都医科大学附属北京胸科医院收治的267例镜下非活动期气管支气管结核患者的临床表现、影像学特征及支气管镜下检查情况。结果:267例患者中,男性79例,女性188例,男女比例为1∶2.38;年龄以20~40岁年龄组为主(55.43%,148/267)。临床表现:胸闷、气促221例(82.77%),咳嗽、咳痰166例(62.17%),发热35例(13.11%),咯血15例(5.62%),无症状20例(7.49%)。非活动期气管支气管结核主要累及部位:左主支气管124例(46.44%),右中间段支气管69例(25.84%),右主支气管48例(17.98%),气管26例(9.74%);左侧∶右侧病变比为1∶0.94(124∶117)。267例患者中,以管壁软化型为主者21例(7.87%),以瘢痕狭窄型为主者198例(74.16%),以管腔闭塞型为主者15例(5.62%),以反复回缩型为主者33例(12.36%);合并肺不张169例(63.30%),并发肺内空洞116例(43.45%),出现肺内多病灶195例(73.03%)。支气管管腔狭窄的CT表现与支气管镜检查检出符合率为98.13%(262/267)。结论:镜下非活动期气管支气管结核以女性、中青年人群多见,最常见症状为胸闷、气促,咳嗽、咳痰;CT检查与支气管镜检查检出符合率高,是镜检前的重要诊断手段。Objective:To investigate the features of inactive central tracheobronchial tuberculosis(tracheobronchial tuberculosis)using different types of microscopes.Methods:The clinical manifestations,imaging features,and bronchoscopic findings of 267 tracheobronchial tuberculosis patients admitted to Beijing Chest Hospital from January 2017 to December 2020 were retrospectively analyzed.Results:Of the 267 cases,79 were male and 188 were female,the ratio of male to female was 1∶2.38;and the patients were mainly 20-40 years old(55.43%,148/267).Common symptoms were dyspnea(221 cases,82.77%),cough and sputum(166 cases,62.17%),fever(35 cases,13.11%),hemoptysis(15 cases,5.62%),and non-symptoms(20 cases,7.49%).The main involved parts of inactive tracheobronchial tuberculosis were left principal bronchus(124 cases,46.44%),right intermediate bronchus(69 cases,25.84%),right principal bronchus(48 cases,17.98%),trachea(26 cases,9.74%),the ratio of left to right was 1∶0.94(124∶117).Among the total 267 cases,21 were soft type(7.87%),198 were stenotic type(74.16%),15 were occlusion type(5.62%),33 were frequent retraction type(12.36%);169 complicated with atelectasis(63.30%),116 complicated with pulmonary cavitation(43.45%),and pulmonary multiple niduses was found in 195 cases(73.03%).The coincidence rate of bronchial luminal stenosis between CT scan and bronchoscope was 98.13%(262/267).Conclusion:Inactive tracheobronchial tuberculosis is common in women,middle-aged and young people.The most common symptoms are dyspnea,cough and sputum.The coincidence rate of CT scan is high,and CT scan is an important diagnostic method before bronchoscopy.

关 键 词：结核 支气管镜检查 疾病特征 体层摄影术 X线计算机 

分 类 号：R521.2[医药卫生—内科学] R81[医药卫生—临床医学]