肺结核临床治愈后残留空洞的诊断再评价

Reassessing the diagnosis of residual pulmonary tuberculosis cavities among healing TB patients.

目的探讨对初治肺结核临床治愈后残留空洞的诊断再评价。方法收集2003年1月至2007年6月上海市(复旦大学附属)公共卫生临床中心和武汉市结核病防治所对初治痰菌阳性肺结核在完成短程化疗后痰菌阴转、达到临床治愈、但X线胸片检查仍残留空洞的67例患者进行支气管肺泡灌洗(BAL)和经皮肺穿刺活检(PLB),对肺结核合并疾病的诊断进行再评价。结果67例患者BAL证实结核杆菌阴性,经过知情同意后,其中的59例患者进行了PLB 62例次,发现肺癌2例次(鳞癌1例,腺癌1例),真菌感染5例次(曲霉菌2例、隐球菌2例、白色念珠菌1例)、结核分枝杆菌阳性5例次、细菌培养阳性3例次(铜绿假单胞菌、鲍曼不动杆菌、产酸克雷伯菌各1例次)。结论即使在肺结核诊断成立并且治疗有效,对肺结核合并疾病的诊断也应该受到高度重视,临床治愈后若残留空洞,仍有必要对诊断进行评价,以免延误肺结核合并的肿瘤和感染性疾病的诊断,必要时需进行BAL或PLB明确诊断。

Objective To elucidate the need of reassessing the diagnosis when residual pulmonary tuberculosis cavities still exist. Methods From Jan 2003 to Jun 2007,67 patients who were initially diagnosed with pulmonary tuberculosis and had already completed a short course treatment were enrolled. All the patients were negative for the sputum TB tests, but still had residual pulmonary cavities. Within three months after the short course treatment, these patients were re-evaluated by bronchoalveolar lavage（BAL）. Fifty-nine of them were also re-evaluated by CT-guided percutaneous lung needle biolpsy（PLB） after receiveing the informed consent from the patients. Results None of the sixty-seven patients was found TB positive by BAL. Among 59 of these patients who had CT-guided PLB, 62 PLB specimens were collected： two specimens were positive for cancer, five for fungi and five for TB, three for bacteria. Conclusion Even when the diagnosis of pulmonary TB infection is confirmed and the anti-TB therapy is effective, the diagnosis of other diseases complicated with TB infection should still be considerd, especially when there are residual pulmonary tuberculosis cavities. To avoid delayed diagnosis of cancer or other infectious disease complicated in pulmonary TB patients,repeated evaluation by using PLB or BAL was encouraged.