结核病流行背景下胸内结节病与结核病临床鉴别与处置专家共识  

Expert consensus on clinical differential diagnosis and treatment of intrathoracic sarcoidosis and pulmonary tuberculosis under the background of tuberculosis epidemic

作　　者：中国防痨协会多学科诊疗分会 《中国防痨杂志》编辑委员会 中华医学会放射学分会临床多学科合作工作组 路希维 曾谊 王凌伟 李智勇 周晖 方芳 李海潮 冯瑞娥 Multidisciplinary Diagnosis and Treatment Committee of the Chinese Anti-tuberculosis Association;Editorial Board of Chinese Journal of Antituberculosis;Clinical Multidisciplinary Cooperation Working Group of the Radiology Branch of the Chinese Medical Association

机构地区：[1]不详

出　　处：《中国防痨杂志》2022年第12期1227-1241,共15页Chinese Journal of Antituberculosis

基　　金：大连市医学重点专科登峰计划项目(21020021T000000006625)。

摘　　要：胸内结节病与结核病均以上皮样肉芽肿为常见病理学特征,两种疾病的影像学特征均表现为多样性,且临床表现具有一定的相似性,容易造成误诊和误治。特别是在结核病流行地区,建立规范的鉴别处置流程具有必要性。为此,中国防痨协会多学科诊疗分会、《中国防痨杂志》编辑委员会和中华医学会放射学分会临床多学科合作工作组联合组织全国多学科专家,在结合临床经验和总结国内外研究结果的基础上,研究制定了《结核病流行背景下胸内结节病与结核病临床鉴别与处置专家共识》。该共识从临床表现、影像学特征、支气管镜检查、病理学诊断与病原学检查等多方面对两种疾病的鉴别进行分类阐述,提出采用多学科合作诊疗模式解决两病鉴别难题,并给出了具体流程和步骤。同时,确定了结节病患者中筛查结核分枝杆菌潜伏感染的目标人群,并就结核分枝杆菌潜伏感染的处置与管理给出了推荐意见,旨在精准施治,改善患者预后。Common pathological features of both intrathoracic sarcoidosis and pulmonary tuberculosis are epithelioid granulomas,and the clinical manifestations of the two diseases are similar to some extent,which may lead to misdiagnosis and mistreatment.It is necessary to establish standardized identification and management procedures for the two diseases,especially in tuberculosis endemic areas.Therefore,the Multidisciplinary Diagnosis and Treatment Committee of the Chinese Antituberculosis Association,Editorial Board of Chinese Journal of Antituberculosis and Clinical Multidisciplinary Cooperation Working Group of the Radiology Branch of the Chinese Medical Association organized multidisciplinary experts to develop an Expert consensus on clinical differential diagnosis and treatment of intrathoracic sarcoidosis and pulmonary tuberculosis under the background of tuberculosis epidemic after combining clinical experiences and summarizing worldwide research results.The consensus provides the differentiation of the two diseases in terms of clinical manifestations,imaging characteristics,bronchoscopy,pathological and etiological examinations.It also proposes a specific framework of confirming the diagnosis of challenging cases through multidisciplinary cooperation with specific procedures and steps.Meanwhile,target population for the screening of potential tuberculosis infection amongst sarcoidosis patients are determined.Additionally,recommendations are given on the treatment and management of latent tuberculosis infection,so as to provide accurate treatment and improve the prognosis of patients.

关 键 词：结节病 结核 肺 诊断 鉴别 总结性报告(主题) 

分 类 号：R81[医药卫生—放射医学] R56[医药卫生—临床医学] R52