178例老年结核性胸膜炎临床流行病学分析

Analysis on clinical epidemiology of l78 casese elder patients with tuberculous pleurisy

目的通过对老年结核性胸膜炎患者的临床症状、诊断、治疗进行分析,探讨老年结核性胸膜炎的发病特点。方法对1998年—2002年收治的60岁及以上的178例老年结核性胸膜炎患者的临床资料进行分析。结果(1)临床症状不典型,以发热、咳嗽、胸闷等呼吸道症状为主诉,而胸痛、盗汗、纳差等结核性胸膜炎中毒症状少见。(2)合并症多(75.8%),一种或多种疾病同时并存。(3)实验室及辅助检查不特异,血性胸水多见,PPD强阳性率低(18.5%),血清或胸腔积液结核抗体检查及胸膜活检有助诊断。(4)延误诊断及误诊率高(47.8%),误诊病例多有不同程度的胸膜粘连、肥厚或形成包裹性积液。(5)非正规抗痨治疗者多(39.3%),且治愈率低(51.7%)。结论掌握老年结核性胸膜炎发病特点,早期诊断,减少误诊,提高防治效果。

Objective To discuss the characters of elder patients with tuberculous pleurisy, through the analysis on clinical symptoms, diagnosis, treatment of elder patients. Methods Retrospectively analysized on clinical data of 178 cases elder patients with tuberculous pleurisy aged over 60 years during 1998-2002. Results （1）The cl iniCal symptoms are atypical,The symptoms of tuberculous pleurisy such as chest pain, night sweat, bad appetite are less than that of respitory such as fever, cough, Stuffy. （2）The complications are more, 135 cases have one or more complications（75.8% ）. （3）Laboratory and supplementary examinations are undistinctive. Blood pleural fluid is more. The intense postive cases of PPD is lower. the examination of tuberculous antibody in serum and in pleural fluid is helpful for diagnosis. （4）The rate of delaying diagnosis and misdiagnosis is higher（47.8% ）. pleural adhesion,thicken and embracing pleural fluid in misdiagnostic cases have different level. （5）Irregular treatment is more （39.3%） and the cure rate cases are lower（51.7% ）. Concllisions Master the characteristics of tuberculous pleurisy in elderly patients, early diagnosis and reducing misdiagnosis,improve the treatment of elder patients with tuberculoius pleurisy.