胸片正常的支气管内膜结核的临床分析

Endobronchial tuberculosis with normal chest radiograph

目的探讨胸片正常的支气管内膜结核(EBTB)的临床特征和临床诊断。方法回顾性分析41例胸片正常的EBTB患者的临床特征和纤维支气管镜(纤支镜)检查。结果本组EBTB患者主要症状有:咳嗽(34例),胸闷气促(12例),咯血(9例),发热(5例),盗汗(4例)。≤35岁组患者25例,其中2例合并有其他慢性疾病,病程平均为(5±4)个月;>55岁组患者7例,有5例合并有其他慢性疾病,病程平均为(10±6)个月,两组比较差异有统计学意义(P<0.01)。纤支镜检查见充血水肿型16例,活动性干酪样坏死型11例,肉芽肿型7例,肿瘤样型2例,溃疡型4例,非特异性支气管型5例,纤维性狭窄型1例。镜下活检病理确诊26例,刷检涂片检查阳性18例,镜下吸引的分泌物或灌洗液抗酸杆菌检查阳性13例。镜检前痰涂片11例阳性,镜检后涂片19例阳性。结论胸片显示正常的EBTB缺乏特异的临床表现,有慢性咳嗽的患者以及合并有糖尿病或其他呼吸系统慢性疾病的老年患者都应警惕EBTB可能。确诊主要依靠纤支镜检查。

Objective To explore the clinical features and the clinical diagnosis of endobronchial tuberculosis （EBTB） with normal chest radiograph. Methods Clinical symptoms and fiberoptic bronchoscopic findings of 41 cases of EBTB with normal chest radiograph were retrospectively analyzed. Results Main symptoms were follows：cough in 34 cases,dyspnea in 12,haemoptysis in 9 ,fever in 5 and night sweats in 4. The average illness duration of the group （including 25 cases） who aged less 35 years old was （5 ± 4 ） months, and in which 2 cases were complicated with others chronic diseases. The duration of the other group （ including 7 cases） who aged over 55 years old was （ 10 ± 6） months,and in which 5 cases were complicated with others chronic diseases. There was significant difference in the two groups. Bronchoscopic results showed 16 cases of edematous - hyperemic type, 11 of actively caseating type ,7 of granular type, 2 of tumorous type ,4 of ulcerative type,5 of nonspecific bronchitic type, 1 of fibrostenotic type, Mucosa biopsy and bacteriology confirmed the diagnosis of 26 cases and 18 cases, 13 cases of antiacid bacillus have been found in the lavage fluid. Positive results were found in 11 cases before fiberoptic bronchoscopy was performed by sputum acidfast staining,and in 19 cases after fiberoptic bronchoscopy was performed. Conclusion The clinical features of EBTB with normal chest radiograph are non - specific. When patients with chronic cough, and old patients with diabetes or others chronic respiratory diseases, EBTB should be suspected. Fiberoptic bronchoscopy plays an important role in the diagnosis of EBTB with normal chest radiograph.