420例气管支气管结核合并肺部结核及肺外结核的临床分析  

Clinical analysis of 420 cases of tracheobronchial tuberculosis combined with pulmonary tuberculosis and extrapulmonary tuberculosis

作　　者：张子扬 徐鹏 刘代顺 Zhang Ziyang;Xu Peng;Liu Daishun(The second Respiratory Department,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China;Institute of Life Sciences,Zunyi Medical University,Guizhou Provincial Key Laboratory of Infectious Diseases and Biosafety,Zunyi Guizhou 563099,China)

机构地区：[1]遵义医科大学附属医院呼吸二科,贵州遵义563099 [2]遵义医科大学生命科学研究院,贵州省普通高等学校传染病与生物安全特色重点实验室,贵州遵义563099

出　　处：《遵义医科大学学报》2022年第2期221-225,共5页Journal of Zunyi Medical University

基　　金：国家自然科学基金资助项目(NO:82060010)。

摘　　要：目的探讨气管支气管结核(TBTB)合并肺部结核及肺外结核的临床特点,以提高临床医师对该病的认识。方法对遵义医科大学附属医院呼吸二科结核病区2011年1月至2018年12月期间资料完整且病原学阳性的420例TBTB住院患者的临床资料进行回顾性分析。结果420例患者男女比例为1∶2.6,年龄13~85岁;症状以咳嗽、咳痰、痰中带血、发热、气促及胸痛多见,阳性占比分别为74.3%、63.6%、44.0%、36.7%、33.8%及24.5%;TBTB合并肺结核和/或肺外结核者占89.5%,其中合并肺结核217例,占51.7%,以继发性肺结核、血行播散性肺结核及纵膈淋巴结结核最多见;TBTB合并肺外结核159例,占37.8%,合并1种、2种、3种和4种肺外结核的分别占54.7%、21.4%、23.3%和0.6%,肺外结核以结核性心包炎、结核性脑膜炎最多见;痰的抗酸染色涂片、结核分枝杆菌培养、TB-LAMP基因检测及GeneXpert MTB/RIF的阳性者分别为310、269、53及132例,61.0%(256/420)的患者有2种或2种以上方法检测结果为阳性。结论TBTB患者女性较多见,临床症状多样,无特征性,常合并其他类型肺结核及肺外结核,临床医师应高度重视其诊治,以避免漏诊、误诊及误治。Objective To investigate the clinical characteristics of tracheobronchial tuberculosis(TBTB)combined with pulmonary tuberculosis and extrapulmonary tuberculosis for improvement of clinician knowledge.Methods The clinical data of 420 TBTB inpatients with complete information and positive etiology from January 2011 to December 2018 were retrospectively analyzed.Results The ratio of male to female in 420 patients was 1∶2.6,and the age ranged from 13 to 85 years.The most common symptoms were cough,expectoration,blood in sputum,fever,shortness of breath and chest pain,with the positive percentages 74.3%,63.6%,44.0%,36.7%,33.8%and 24.5%,respectively;TBTB combined with pulmonary tuberculosis and extrapulmonary tuberculosis accounted for 89.5%.217 cases were combined with pulmonary tuberculosis,accounting for 51.7%,which mainly consisted of secondary pulmonary tuberculosis,hematogenous pulmonary tuberculosis and mediastinal lymph node tuberculosis.159 cases of TBTB combined with extrapulmonary tuberculosis main including pericarditis and tuberculous meningitis,accounting for 37.8%,concomitent with 1,2,3,and 4 types of extrapulmonary tuberculosis accounted for 54.7%,21.4%,23.3%,and 0.6%,respectively.310 cases were positive detected by acid-fast stained smear of sputum,while 269 cases by culture,53 cases by TB-LAMP,and 132 cases by GeneXpert MTB/RIF.61.0%(256/420)of the cases had positive results by at less two detecting methods.Conclusion TBTB patients are more common in females,with various clinical symptoms and no characteristics,which is often combined with other types of pulmonary tuberculosis and extrapulmonary tuberculosis.Clinicians should pay more attention to the diagnosis and treatment to avoid missed diagnosis,misdiagnosis and mistreatment.

关 键 词：气管支气管结核 肺外结核 临床分析 

分 类 号：R523[医药卫生—内科学]