结核性大叶性肺炎误诊分析

Analysis of lobar pneumonic tuberculosis

目的提高对结核性大叶性肺炎（或称大叶性肺炎型肺结核）的认识。方法对１０例结核性大叶性肺炎进行了综合分析。结果１０例患者均以急性发病形式起病，９例表现为持续高热，血象均低于１０×１０９／Ｌ，胸部Ｘ线片均示肺叶分布的渗出性病变，且在短期内可有明显改变。全部患者均对抗生素治疗无效，治疗中病灶可于短期内显著增大，抗结核治疗后病灶则可于短期内明显吸收，且无空洞形成。结论早期行经支气管壁肺活检（ＴＢＬＢ）和（或）支气管内膜刷检可助早期诊断和早期治疗。

Objective To heighten the awareness of lobar pneumonic tuberculosis(or tuberculous pneumonia or acute pneumonic tuberculosis). Method 10 cases with lobar pneumonic tuberculosis were reviewed.Result All the patients showed acute onsets and 9 of them had a continuous high fever, and their WBC was not found higher than 10×10 9/L.All of the patients' chest radiographs showed a consolidation in one or two lobars, and in 30% of the patients pleural effusions were found. Significant roent genographic changes could occur in short duration. All the patients were not sensitive to common antibiotics, and the shadow could enlarge in short time. Exudative foci could be absorbed shortly after antituberculosis chemotherapy, and no cavitation was found. Conclusion An early transbroncho lung biopsy (TBLB) and (or) brushing smear may be advantageous to early diagnosis and treatment of this illness.