痰结核杆菌阴性L型菌阳性肺结核临床观察

Clinical observation on patients with pulmonary tuberculosis negative for sputum M. tuberculosis and positive for L-form of M. tuberculosis

目的了解痰结核杆菌(-)L型菌(+)肺结核患者的临床表现,探讨其临床特点。方法对204例痰抗酸染色涂片及结核杆菌培养均阴性的肺结核患者做痰标本结核杆菌L型菌分离培养,比较分析60例L型菌(+)组及144例L型菌(-)的肺结核组的主要症状、X线表现及治疗结果。结果痰结核杆菌阴性肺结核L型菌检出率为29.4%,L型菌(+)组患者的干酪病灶和干酪空洞多于L型菌(-)组,L型菌(-)组患者的病灶显吸率高于L型菌(+)组。结论结核杆菌L型菌的存在,提示病变有活动性,结核病的治疗必须坚持合理的全程化疗,直至痰中消灭结核杆菌L型菌。

Objective To study the clinical features of pulmonary tuberculosis negative for sputum M. tuberculosis and positive for L-form of M. tuberculosis. Methods The samples of sputum from 204 cases of pulmonary tuberculosis negative for smear and culture were cultured for L-form of M. tuberculosis. The major manifestations, X-ray features and therapeutic effect were compared between 60 L-form positive patients and 144 cases negative ones. Results The rate of L-form positive cases was 29.4%. The caseous lesion and cavity were more serious and the rate of foci absorption was significantly higher in the L-form negative cases than in L-form positive ones. Conclusiom The existence of L-form of M. tuberculosis suggests that the tubewulous lesion is active. A reasonable regimen should be persisted during the whole course until the elimination of L-form of M. tuberculasis in sputum in the L-form positive patients.