吸收延迟肺炎误诊肺结核16例分析及误诊原因探讨

Analysis on 16 delayed absorption pneumonia cases misdiagnosed as pulmonary tuberculosis

目的探讨吸收延迟肺炎误诊肺结核的原因,提高对两种疾病的鉴别诊断能力。方法对16例吸收延迟肺炎误诊肺结核病例进行回顾性分析。结果误诊患者临床表现发热10例,其中高热3例,中度发热4例,低热3例;盗汗2例;查痰结核菌均阴性;血常规检查白细胞总数在4.0～10.0×109/L之间12例;结核菌素纯蛋白衍生物(PPD)皮试阳性7例;X线胸片病变位于上叶尖后段、下叶背段16例;有肺结核病史2例。结论误诊的主要原因:吸收延迟的肺炎临床症状不典型,X线胸片、血常规检查与肺结核相似,对PPD的诊断价值估计过高。对临床资料综合分析,抗炎治疗动态观察,是防止吸收延迟的肺炎误诊肺结核的重要措施。

Objective To investigate the causes for delayed absorption pneumonia patients misdiagnosed as pulmonary tuberculosis and to improve the clinical differential diagnosis ability on these two pulmonary diseases. Methods Retrospective analysis of 16 cases with delayed absorption pneumonia who were misdiagnosed as pulmonary tuberculosis. Results The clinical symptoms of these patients included 10 cases with fever,among whom 3 cases had high grade fever,4 cases had medial grade fever and 3 cases had low grade fever;2 cases with night sweat.All patients had negative acid fast bacteria;Of 16 cases 12cases showed that WBC were 4.0～10.0×109/L,7 cases were positive on TST result used PPD 5IU,16 cases＇ lesion located in the apical and rear segments of the upper lobes or the superior segments of the lower lobes,2 cases had the history of pulmonary tuberculosis. Conclusion The main causes of misdiagnosis are as follows： the clinical symptoms of delayed absorption pneumonia are atypical,Chest X-ray appearance and routine blood test results are similar to that of pulmonary tuberculosis and the diagnostic value of PPD test is over-estimated.Comprehensive analysis of the clinical data and observing the focus dynamically after anti-inflammatory treatment should be important measures to avoid delayed absorption pneumonia misdiagnosed as pulmonary tuberculosis in clinical practice.