肺结核合并肺部感染的临床特征及病原学研究

The clinical characteristics and pathogenic agents about tuberculosis patients subsequent pulmonary infection

目的探讨肺结核合并肺部感染的临床特征及相关的病原学。方法经纤支镜防污染毛刷（PSB）及肺泡灌洗采样（BAL）行致病菌定量培养，PSB细菌定量培养≥10^3cfu／ml或BAL细菌定量培养≥10^5cfu／ml诊断为合并肺部感染，分析两组的临床特征及病原学。结果两组中发热〉38℃、咳脓痰、肺部啰音、WBC10～15×10^9／L且N〉0．7、WBC〉15×10^9／L、特异胸片改变等临床征象在合并肺部感染与非合并肺部感染患者之间有显著性差异。肺结核合并肺部感染的病原菌首位是肺炎克雷伯菌、其次是铜绿假单胞菌。真菌感染病原体主要是曲菌、白色念珠菌。结论特异临床特征对诊断肺结核肺部感染有一定意义，病原学检测可进一步明确诊断。

Objective To further understanding tuberculosis patients subsequent pulmonary infection through studying the clinical characteristics and pathogens. Methods Quantitative cultures of bronchealveolar lavage （BAL） and specimen brush （PSB） were used through flxible fiberoptic bronchoscopy. Quantitative cultures of PSB ≤ 10^3 cfu/ml or BAL ≥ 10^5 cfu/ml were diagnosis tuberculosis patients subsequent pulmonary infection. We analyzed their clinical characteristics and pathogens. Results The major clinical features of pulmonary tuberculosis complicated by lung infection were as follows：Fever 〉 38℃, purulent sputum, rales, WBC 10 - 15 × 10^9/L, N 〉 0. 7, WBC 〉 15 × 10^9/l Chest film change. Pathogens in tuberculosis patients subsequent pulmonary infection are as follows： Klebsiella pneumoniae, Pseudomonas are uginosa. Conclusion The clinicl characteristics is in favour of making diagnosis tuberculosis patients subsequent pulmonary infection in pulmonary tuberculosis. The examination of pathogenic organisms is useful of diagnosis.