骨髓结核的诊断和治疗

Diagnosis and treatment of tuberculosis of bone marrow

目的探讨骨髓结核的诊断和治疗。方法对１９９０～１９９７年２４１０例行骨髓活组织检查（活检）病例中诊断为骨髓结核的１１例的临床及病理资料作回顾性分析。结果高热、乏力、消瘦、贫血１１例，腹胀、腹痛４例，腹水３例，肝脾肿大５例。１１例均无骨关节的局部症状与体征。痰涂片抗酸杆菌均阴性，肝功能受损９例，检查的６例血沉均升高，为３０～１６８ｍｍ／１ｈ。胸片示血行播散型肺结核４例，７例胸片未见结核病变。病理检查１１例发现结核性肉芽肿，６例发现干酪样坏死，３例肉芽肿组织抗酸染色查到抗酸杆菌。１０例除有骨髓结核外，尚伴有一种或多种其他部位的结核病变。８例经联合抗结核化疗好转出院，３例死亡。结论骨髓结核是血行播散型结核在骨髓的病变，临床表现缺乏特异性。对长期高热待诊的病例，应考虑血行播散型结核的可能，除了寻找常见的肺部病变外，必要时可考虑行骨髓活检。骨髓结核一经诊断。

Objective To explore appropriate diagnosis and treatment of tuberculosis of bone marrow. Method Clinical and pathologic data of 11 cases with tuberculosis of bone marrow out of 2 410 cases underwent biopsy from 1990 to 1997 were retrospectively analyzed. Result High fever, weariness, emaciation and anaemia were found in 11 cases, abdominal distension and abdominal pain in 4, ascites in 3, liver and spleen enlargement in 5. All the cases had no local osteoarticular abnormalities. Negative sputum smear acidfast staining results were found in 11 cases, abnormal liver function in 9, increased erythrocyte sedimentation rate (30～168 mm/1h) in 6 detected. Chest radiographs showed hematogenous disseminated pulmonary tuberculosis in 4 cases, no tuberculous lesion in 7. Tuberculous granulomas were found in 11 cases, caseous necrosis in 6, and positive granulomatous tissue acidfast staining results in 3. Ten out of 11 cases accompanied tuberculous lesions in other parts of body except bone marrow. Eight cases recovered after combined antituberculosis chemotherapy, and other 3 died. Conclusion Tuberculosis of bone marrow is the bone marrow involvement of hematogenous disseminated tuberculosis with nonspecific manifestations. Possibility of hematogenous disseminated tuberculosis should be considered in patients with longterm high fever, and in addition to common pulmonary abnormalities, the bone marrow biopsy should also be taken into consideration. Moreover, combined antituberculosis chemotherapy should be given immediately after the diagnosis of the disease.