5050例肺结核病患者病理学观察

Pathologic review of 5 050 pulmonary tuberculosis cases

目的总结肺结核病的病理形态学改变及其与联合化疗方案之间的关系。方法观察５０５０例肺结核患者的病理学改变，并对ＨＳＰ、ＨＲＳ和ＨＲＺＳ三种不同联合化疗方案与各型肺结核病理变化的关系进行分析。结果经ＨＲＳ和ＨＲＺＳ治疗的病例中，干酪空洞和纤维空洞手术切除率明显下降，与ＨＳＰ联合化疗方案相比有显著性差异（Ｐ＜０．０１）。经ＨＳＰ、ＨＲＳ和ＨＲＳＰ化疗方案治疗后，结核球的手术切除率分别为２６．８２％（８９７／３３４５）、４１．２４％（４６４／１１２５）和４７．８％（２７７／５８０），呈现上升趋势（Ｐ＜０．０１）。并发现４２例净化性空洞患者。结论并用利福平和吡嗪酰胺的联合化疗对肺结核病理类型有一定影响，导致结核球比例上升，干酪和纤维空洞比例下降。

Objective To summarize the pathomorphologic changes of pulmonary tuberculosis and the relationship between those changes and the combined chemotherapy regimens. Methods Observing the pathological changes in 5 050 cases with pulmonary tuberculosis, and the relationship between three different combined chemotherapy regimens HSP, HRS, HRZS and the pathological changes of pulmonary and bronchial tuberculosis. Results The rate of surgical excision of caseous cavities and fibrous cavities declined markedly in cases treated by HRS and HRZS regimens ( P <0.01). Whereas, after treated by HSP, HRS and HRZS regimens, the rate of surgical excision of tuberculoma were 26.82%(897/3 345), 41.24%(464/1 125) and 47.8%(277/580) respectively which showed a rising tendency ( P <0.01). Open healing cavities were found in 42 patients. Conclusions The effects of combined rifampicin and pyrazinamide chemotherapy caused the changing of pathologic types of pulmonary tuberculosis, that is: the increased proportion of tuberculoma and the decreased proportion of caseous and fibrous cavities. Tuberculoma ought to be taken into account in the classification of tuberculosis.