肺炎误诊肺结核57例分析

Analysis of 57 pneumonia cases misdiagnosed as pulmonary tuberculosis

目的 了解肺炎误诊肺结核的因素.方法 对内科57例肺炎误诊肺结核病例进行回顾性分析.结果 误诊率22.3%(57/256);临床表现为午后发热56%,盗汗28%,痰中带血17.5%,X线胸片病变位于肺尖后段、下叶背段占59.6%;白细胞总数在4.0×109～10.0×109/L占64.9%;痰普培阳性14%.结论 (1)误诊原因:临床症状不典型,胸片及血常规检查难与肺结核区别;(2)预防措施:对胸片显示斑片阴影、临床症状不典型者可用广谱抗生素行至少2周抗菌治疗观察,反复痰查结核菌及普通细菌培养,不宜选用链霉素或利福平抗菌治疗.

Objective To understand the factors that influence pneumonia patients to be misdiagnosed as pulmonary tuberculosis.Methods Retrospective analysis of 57 Cases of pneumonia who were misdiagnosed as pulmonary tuberculosis.Results The misdiagnosis rate was 22.3%(57/256).Their clinical symptoms were as follow: 28% had sweats at night,56% had fever in the afternoon,17.5% hemoptysis.59.6% showed the pathological changes in the chest X-ray photos,which located in the apical and rear segments of the upper lobes or the superior segments of the lower lobes.Routine blood test showed that 64.9% patients' WBC were 4.0×109~10.0×109/dl and 14% sputum cultures were positive.Conclusions (1) Cause of misdiagnosis: The clinical symptoms were atypical,chest X-ray appearance and routine blood test results of pneumonia patients were difficult to differentiate with pulmonary tuberculosis.(2) Preventive interventions: The patients with patchy shadow in chest X-ray photos and atypical clinical symptoms should be treated with broad-spectrum antibiotics for at least two weeks,and SM and RFP should be avoided;sputum smear for acid-fast bacilli and sputum culture for mycobacteria should be done repeatedly.