49例肺炎误诊肺结核分析

Analysis of 49 pneumonia cases misdiagnosed as pulmonary tuberculosis

目的探讨肺炎误诊肺结核的原因及其对策。方法对49例肺炎误诊肺结核患者进行分析。结果临床表现为午后低热57.1%,咯血32.7%,盗汗28.6%;X线胸片病变位于上叶尖后段、下叶背段71.4%;白细胞总数在4.0～10.0×109/L之间占69.4%,结核菌素纯蛋白衍生物(PPD)皮试阳性61.2%,培养阳性18.4%。结论误诊的主要原因:肺炎临床症状不典型;胸片、血常规检查与肺结核相似;对结核菌素的诊断价值估计过高和细菌培养阳性率过低。防治对策:重视病原学检查、血清抗体检测和临床资料的综合分析是防止肺炎误诊肺结核的重要措施。

Objective To investigate the reasons and strategies for pneumonia patients misdiagnosed as pulmonary tuberculosis. Methods Retrospective analysis of 49 cases with pneumonia who were misdiagnosed as pulmonary tuberculosis were performed. Results The clinical symptoms of 49 pneumonia cases including 57. 1% low grade fever, 32.7% hemoptysis, 28.6% night sweat. 71.4% the pathological changes in the chest X-ray photos, which located in the apical and rear segments of the upper lobes or the superior segments of the lower lobes. Routine blood test showed that 69.4% WBC were 4. 0 - 10. 0 × 10^9/L. 61.2% PPD test were positive, 18.4% cultures were positive. Conclusion The main cause of misdiagnosis ： the clinical symptoms of pneumonia are atypical. Chest X-ray appearance and routine blood test results are similar to that of pulmonary tuberculosis. The diagnostic value of PPD test is estimated highly. The positive rate of pathogen culture is low. Control strategies as follows ： Strengthening pathogenic examination, detection of sew-antibody and comprehensive analysis of the clinical data should be important measures in avoiding atypical pneumonia misdiagnosed as pulmonary tuberculosis.